Medication at discharge in an orthopaedic surgical ward: quality of information transmission and implementation of a medication reconciliation form.

Background Medication reconciliation (MedRec) at discharge is a cumbersome but necessary process to reduce the risk of medication errors at transitions of care. The main barriers to implementing such a process are the large number of professionals involved and a lack of collaboration among caregivers. Objective This study was designed to assess the need for a medication reconciliation form at discharge in an orthopaedic surgical ward. Setting The study was conducted in the orthopaedic surgery ward among inpatients at a 407-bed French teaching hospital. Method We first performed a retrospective audit to evaluate the quality of discharge medication information in the medical record, after which a 5-week prospective study was conducted in 2013. All patients admitted to the orthopaedic surgery unit who had at least two chronic diseases and three medications underwent MedRec at discharge. We designed a Best Possible Medication at Discharge List (BPMDL) to be completed by hospital staff and transmitted to community caregivers. Mean outcome measures We assessed the completeness of medication information in the medical records, discrepancies between medications noted on the BPMDL and those prescribed on the discharge order, and the value of the BPMDL for stakeholders. Results Thirty patients were included in the study. Only 4 % of medical records contained a discharge summary with complete medication information. In 67 % of cases, treatment discontinuations at admission were justified, and medications were reintroduced before discharge, while 107 treatments (45 %) were added but not prescribed on discharge orders. Discontinuations prior to discharge were justified in 60 % of cases (treatments were ended or supportive treatment was required during hospitalization). An average of 2.1 treatments were prescribed on discharge orders (vs. 9.4 prescribed on the BPMDL). Patients, general practitioners (GP), and physicians in long-term care settings (PLTCS) rated the format, content, and readability of the BPMDL as satisfactory, and it was found to be of value for patients and PLTCS to support medication information. Because of the very low response rate among GP (10 %), we were unable to determine their satisfaction with the MedRec discharge process. Conclusion The transmission of patient medication information at discharge is often lacking. As such, the BPMDL appears to have value to both patients and community health providers. Because this study was conducted within a single surgical unit, further study in other surgical wards is needed to assess generalizability.

Ketogenic diet exhibits anti-inflammatory properties.

The ketogenic diet (KD) is an established treatment for refractory epilepsy, including some inflammation-induced epileptic encephalopathies. In a lipopolysaccharide (LPS)-induced fever model in rats, we found that animals given the KD for 14 days showed less fever and lower proinflammatory cytokine levels than control animals. However, KD rats exhibited a decrease in circulating levels of arachidonic acid and long-chain n-3 polyunsaturated fatty acids (PUFAs), suggesting that the anti-inflammatory effect of KD was probably not due to an increase in anti-inflammatory n-3 PUFA derivatives. These properties might be of interest in some conditions such as fever-induced refractory epileptic encephalopathy in school-aged children.

[Representation and practice about "chimical restraints": qualitative study with 50 health worker]. / Interprétation et pratiques autour du terme "contention chimique" : étude qualitative auprès de 50 professionnels de santé.

The term "chemical restraints" seems to be used in medical practice, but does not have the same meaning for all French health care professionals. In available literature it is considered as use of psychotropic medications for behavioral disorders. We used qualitative research method based on semi-directive interviews, in order to better understand meaning of "chemical restraint" term for geriatric medical and paramedical personnel. This term is well understood, rarely used, wrong for some professional because "drugs do not hold". The term of "physical restraint" has a more tangible reality. The term of "sedation of psychocomportemental troubles" is more common and seems to have a less pejorative connotation. In practice chemical restraint may correspond to emergency use of benzodiazepines or neuroleptics by injection at doses leading to the patient's sedation without his consent.

Reducing medication errors at admission: 3 cycles to implement, improve and sustain medication reconciliation.

BACKGROUND: In France, medication errors are the third leading cause of serious adverse events. Many studies have shown the positive impact of medication reconciliation (MR) on reducing medication errors at admission but this practice is still rarely implemented in French hospitals. OBJECTIVE: Implement and sustain a MR process at admission in two surgery units. The quality improvement approach used to meet this objective is described. SETTING: The gastrointestinal surgery and orthopedic surgery departments of a 407 inpatient bed French teaching hospital. METHODS: A step by step collaborative approach based on plan-do-study-act (PDSA) cycles. Three cycles were successively performed with regular feedback during multidisciplinary meetings. MAIN OUTCOME MEASURE: mean unintended medication discrepancies (UMDs) per patients at admission. RESULTS: The three PDSA cycles and the monitoring phase allowed to implement, optimize and sustain a MR process in the two surgery units. Cycle 1, by showing a rate of 0.65 UMDs at admission (95 % CI 0.39-0.91), underlined the need for a MR process; cycle 2 showed how the close-collaboration between pharmacy and surgery units could help to reduce mean UMDs per patients at admission (0.18; 95 % CI 0.09-0.27) (p < 0.001); finally, cycle 3 allowed the optimization of the MR process by reducing the delays of the best possible medication history availability. CONCLUSIONS: This work highlights how a collaborative quality-improvement approach based on PDSA cycles can meet the challenge of implementing MR to improve medication management at admission.

Oral administration of docosahexaenoic acid/eicosapentaeinoic acids is not anticonvulsant in rats: implications for translational research.

Omega-3 and omega-6 poly-unsaturated fatty acids (PUFAs) are dietary fatty acids that are involved in a myriad of physiological processes in the brain. Although experimental data have shown that PUFAs have anticonvulsant properties, the outcomes of clinical trials have been controversial. Docosahexaenoic acid (DHA) is a PUFA which has been reported to exert anticonvulsant effects. Here we studied anticonvulsant potential of a mixture of enriched n-3 PUFA upon their oral administration in rats. We did not observe an anticonvulsant effect of n-3 PUFA in the i.v. pentylentetrazol threshold test. n-3 PUFA component was increased in the plasma of rats treated with the eicosapentaenoic acid (EPA)/DHA mix (275 mg/kg/d/400 mg/kg/d) due to the increase of both DHA and EPA. We also found modification of PUFA composition in the brain. Despite PUFA profiles modified both in plasma and in the brain, we did not find any anticonvulsant effect of orally administered DHA. Further studies are needed to define the type and the amount of fatty acids that would possess anticonvulsant properties. As the existing literature suggests that the route of administration of PUFA may be crucial, future studies should involve oral administration to provide relevant clinical information.