[Consumption of narcotics, substances assimilated to narcotics and psychotropic drugs in health establishments: Profile of a hospital from France and a hospital from Quebec]. / Consommation des stupéfiants, substances assimilées aux stupéfiants et psychotropes en établissement de santé : profil d'un hôpital français et d'un hôpital québécois.

OBJECTIVES: The objective was to describe the trends in the consumption of narcotic drugs, substances related to narcotic drugs (SAS) and psychotropic drugs between a French hospital and a Quebec hospital between 2013 and 2017. METHODS: This is a retrospective descriptive study. The consumption data was obtained from the pharmacy management software and was extracted by financial year (January 1st, 2013 to December 31st, 2017 for the French hospital and April 1st, 2013 to March 31st, 2018 for the Quebec hospital). For each drug considered to be narcotics, SAS and psychotropic drugs in France or subject to the legislation on designated substances in Quebec, we identified the quantities consumed from 2013 to 2017. The data werepresented according to the following therapeutic classes: opioids (N02A), other analgesics (N02B), anxiolytics (N05B), hypnotics and sedatives (N05C), general anesthetics (N01A), psychostimulants (N06B), androgens (G03B) and antagonists peripheral opioid receptors (A06A). The data were expressed as a defined daily dose (DDJ) for 1000 patient-days (PDs). RESULTS: In the French hospital, the consumption of narcotics, SAS and psychotropic drugs varied from 676 to 560 DDJ per 1000 PDs between 2013 and 2017. While it varied from 1019 to 756 DDJ per 1000 PDs between 2013 and 2017 in the Quebec hospital. In 2017, the most widely used therapeutic classes in French hospitals were, in decreasing order, anxiolytics (211 DDJ per 1000 PDs) (i.e. alprazolam), opioids (205 DDJ per 1000 PDs) (i.e. tramadol, morphine injectable) and hypnotics and sedatives (64 DDJ per 1000 PDs) (i.e. midazolam injectable). In Quebec hospitals, the three therapeutic classes the most used in 2017 were, in decreasing order, opioids (314 DDJ per 1000 PDs) (i.e. hydromorphone injectable, morphine injectable), anxiolytics (221 DDJ per 1000 PDs) (i.e. clobazam) and hypnotics and sedatives (108 DDJ per 1000 PDs) (i.e. midazolam injectable). CONCLUSION: This study notes a decrease in the consumption of opioids and other substances in both the French and Quebec establishments between 2013-2017. More work is needed to better describe the differences observed between the profile of each establishment. This is why monitoring consumption trends, therapeutic indications and preventive measures are essential.

[Exploration of the evolution of antibiotic consumption according to the WHO AWaRe classification, in a mother-child university hospital]. / Exploration de l'évolution de la consommation d'antibiotiques d'un centre hospitalier universitaire mère-enfant selon la classification AWaRe de l'Organisation mondiale de la santé.

BACKGROUND: Different measures of antimicrobial are used to ensure proper usage, as part of structured antimicrobial stewardship programs. OBJECTIVE: The main objective of this study is to describe the consumption of antibiotics in a mother-child teaching hospital using the AWaRe classification over a period of 15 years. METHODS: This descriptive and retrospective study included all the data on antibiotic consumption of patients admitted to mother-child University Hospital from April 1st 2005 to March 31st, 2021. Of the 180 international non-proprietary names of antibiotics proposed by the World Health Organization (WHO), 54 were used. The number of days of treatment (DOT) per 1000 patient-days (PD) was calculated per year, per patientele (e.g. surgery, pediatrics, oncology, intensive care, neonatal intensive care, nursery, psychiatry, rehabilitation and obstetrics and gynecology) and globally. The data was classified per the WHO AWaRe classification. RESULTS: A total of 10,489 DOT/1000PD were used globally in 15 years, corresponding to 53.9% of the "Access" group, 45.2% of the "Watch" group and 0.9% of the "Reserve" group. A reduction in the use of antibiotics was noted. The ratios of antibiotic consumptions in DOT/1000PD of 2020-2021 to 2005-2006 were 0.84 globally (1713/5653), 0.79 for the "Access" group (286/361), 0.89 for the "Watch" group (270/302) and 0.88 for the "Reserve" group (2.1/2.4). CONCLUSION: The AWaRe classification was used to describe the consumption of antibiotics in a mother-child center. Our consumption compared favorably with international data and is in line with the WHO targets. This position may be linked to the presence of a structured anti-biogovernance program that has been in place for several years within our hospital. More work is needed to more precisely identify the antibiotics that should benefit from better supervision.

[Recommendations for performing pharmacogenetic tests in drug monographs in Canada, France and the United States]. / Recommandations relatives à la réalisation de tests de pharmacogénétique dans les monographies de médicaments au Canada, en France et aux États-Unis.

INTRODUCTION: Pharmacogenetics represents an opportunity in pharmaceutical practice. There are many documentary resources to support the pharmacist's work in this area. OBJECTIVE: To compare the recommendations for carrying out pharmacogenetic tests from a documentary source in three countries: the United States, Canada and United France. METHOD: This is a cross-sectional descriptive study. Based on the recommendations of the Clinical Pharmacogenetics Implementation Consortium type A (the highest threshold justifying the use of a pharmacogenetic test), we identified the drug-gene pairs (23 pairs). The proposed pairs involve a total of 47 separate international nonproprietary names and 18 genes. For each drug-gene pair, we consulted three open access documentary sources (one for each target country), namely the pharmaceutical products database (DPD) for Canada, the product characteristic summary (SPC) for France and the Micromedex® monograph (IBM, Truven Health Analytics, MI, USA) for the United States. The study was conducted in September 2019. RESULTS: About a third of the drug-gene pairs are explicitly mentioned by the gene to be targeted and by the test suggested in the documentary sources consulted. Of the 23 pairs identified by the CPIC, thirteen pairs contain "consistent" recommendations between the three documentary sources. CONCLUSION: There is great heterogeneity regarding the recommendations for pharmacogenetic tests from three documentary sources used by pharmacists to monitor drug therapy in the United States, Canada and France. There is an urgent need to standardize the requirements for nomenclature, description and the need to use pharmacogenetic tests to ensure proper use of drugs and these tests in the clinic.

Identification of discrepancies between adverse drug reactions coded by medical records technicians and those reported by the pharmacovigilance team in pediatrics: An intervention to improve identification, reporting, and coding.

OBJECTIVE: To identify the discrepancies between the adverse drug reactions (ADRs) identified by medical records technicians and the ADRs identified by the pharmacovigilance team, and to validate the quality of the information collected by the medical records technicians. To propose improvements to the method for detection of serious ADRs by medical records technicians and the pharmacovigilance team to meet the new requirements of Canada's amended Food and Drug Act (Vanessa's Law) and its regulations. METHODS: This was a descriptive and retrospective study. We included all ADRs identified by medical records technicians in the coding of records after hospitalization, including active ADRs present at admission or identified during hospitalization between 1 April 2017 and 31 October 2017, and all ADRs identified and reported by the pharmacy through its pharmacovigilance program during the same period. We identified the discrepancies between the two identification systems and revised all cases from patient records. In addition, we identified improvements in the method for detecting and reporting serious ADRs. RESULTS: This study identified 343 ADRs, 322 of which were coded by the medical records technicians and 21 identified by the pharmacovigilance team for a period of 7 months in a mother-child university hospital center. Only 1.5% of the ADRs were identified by both medical records technicians and the pharmacovigilance team. The code Y43, which corresponds to the largest number of identified ADRs, mainly includes anticancer drugs and immunosuppressant drugs. Three corrective actions were set up: 1) implementation of a form to explain the addition and coding of an ADR to a patient's file, 2) weekly transmission of a working file between the medical records technicians and the pharmacovigilance team so that the files would be reviewed and a declaration made to the regulatory authority, and 3) creation of a standardized pharmacist's note to add to the patient file. CONCLUSION: It is possible to increase the reporting of ADRs, improve the quality of coding, and reduce discrepancies between the ADRs coded by these two teams through a structured intervention.

[Evolution of the legal and normative framework surrounding the practice of hospital pharmacy and the correct use of drugs in Quebec]. / Évolution du cadre juridique et normatif entourant l'exercice de la pharmacie hospitalière et le bon usage des médicaments au Québec.

OBJECTIVES: The objective was to identify the main texts applicable to the practice of pharmacy in Quebec, then count the specific number of recommendations and criteria and describe the evolution of the legal and normative framework. METHODS: This is a descriptive and retrospective study of the main texts applicable to the legal and normative framework for the practice of pharmacy on January 1st, 2019. RESULTS: A total of 107 texts relating to the practice of pharmacy in Quebec were identified. They come from the legislator (53.1 %), the Order of pharmacists (26.1 %) or other organizations (20.8 %). These were laws/regulations (n=59), contributing to the optimal use of drugs (n=18), relating to hospital pharmacy management (n=18), the provision of pharmaceutical care (n=11), drug preparation (n=3), oncology practice (n=2) or health and safety at work (n=1). Thirty-three texts were considered for enumeration of recommendations and explicit criteria, for a total of 235 recommendations and 3703 explicit criteria applicable to the practice of hospital pharmacy in Quebec. CONCLUSION: There is a significant increase in the number of texts, recommendations and criteria applicable to the practice of hospital pharmacy in Quebec. Compliance with this legal and normative framework appears to be a considerable challenge for hospital pharmacists. It seems worthwhile to further promote discussion with text-issuing agencies in order to keep the search for compliance realistic.

[Indicators of research impact: Tools for measuring journals, researchers and published articles in health - Pharmaceutical perspective]. / Indicateurs de notoriété des revues scientifiques, des chercheurs et des articles publiés en santé : perspective pharmaceutique.

There are several indicators to evaluate the impact of the scientific publication in pharmacy. Given their number, complexity, heterogeneity, strengths and weaknesses, we believe that pharmacists are not sufficiently familiar with these indicators. The main objective is to present an inventory of available indicator to measure the research impact. PubMed, GoogleScholar and Google were interviewed in October 2017 from the following terms: bibliométrique/bibliometrics, facteur d'impact/impact factor, impact de citations/citation impact, revue/journal, chercheur/researcher, article, indicateur/indicator, score. For each identified indicator, the following variables were extracted: name, calculation method, calculation time window, data sources considered, access conditions, inclusion of self-citation, strengths and weaknesses. A total of 15 indicators were included: seven for journals, four for researchers and four for articles. Among them two are non-bibliometric indicators: the Altmetric attention score, the RGscore and one other indicator deriving from the impact factor: the SIGAPS indicator developed to finance the research activity of French hospitals. Of the 12 bibliometric indicators, nine include self-citation. All involve forces (e.g. exclusion of editorials, letters, free access) and weaknesses (e.g. self-citations included, time window too short, disciplinary indistinction). There is no indicator with no weaknesses and pharmacists should be able to understand their strengths and weaknesses.

Drug shortages in Canada: Data for 2016-2017 and perspectives on the problem.

OBJECTIVES: Many signs point to the growing importance of drug shortages in Canada and around the world. Although drug shortages affect clinicians and patients every day, there is a paucity of literature describing the specific problems experienced and their clinical consequences. To describe the drug shortage situation in Canada in 2016-2017 and to discuss this issue in the Canadian context. METHODS: This retrospective study was based on data from one Canadian wholesaler (McKesson Canada) and the official Drug Shortages Canada website. RESULTS: From August 31, 2016, to September 4, 2017, the McKesson database showed 583 drug shortages, averaging 160 (standard deviation [SD] 180) days, and the drug shortage website showed 2,129 shortages, averaging 118 (SD 113) days. Of these shortages, 26% in the McKesson database and 14% at the official drug shortage website were for parenteral products. In both the McKesson database and the Canadian drug shortage database, the leading drug classes with shortages were central nervous system drugs (26.4% and 31.8%, respectively), cardiovascular drugs (12.0% and 21.9%), anti-infective agents (11.2% and 8.5%), gastrointestinal drugs (7.9% and 6.2%) and antineoplastic agents (7.4% and 5.1%). CONCLUSIONS: This descriptive study highlights the high number of shortages in Canada in 2016-2017. The new federal regulation requiring declaration of drug shortages should lead to better monitoring of this problem at the national level. Although the causes of shortages are often identified, manufacturers and regulators are frequently unable to address or effectively prevent drug shortages.

[Evaluation of knowledge and perceptions of pharmacists and residents pharmacists about bibliometric indicators applied to the scientific literature in pharmacy]. / Évaluation des connaissances et perceptions des pharmaciens et internes en pharmacie sur les indicateurs de notoriété appliqués à la publication scientifique en pharmacie.

OBJECTIVES: Evaluate the level of knowledge and perceptions of French and Quebec hospital's pharmacists/residents about bibliometrics indicators applied in pharmacy. Identify the determinants associated with this knowledge. METHODS: This is a descriptive cross-sectional study. An anonymous questionnaire of 17 questions answers was developed. The questionnaire was published on the SurveyMonkey site (www.SurveyMonkey.com, SurveyMonkey, Portland, OR, USA) and released from March 19 to April 9, 2018. We calculated and compared the proportion of respondents in Quebec and France by using a Chi2 test. A value less than 0.05 is considered statistically significant. RESULTS: A total of 899 pharmacists (646 in Quebec and 253 in France) and 147 residents (70 in Quebec and 77 in France) were contacted by email. The survey was completed by 401 respondents, e.g., 301 in Quebec (participation rate: 42%) and 100 in France (30%). Overall 26% (106/401) of respondents (67/301 in Quebec vs. 39/100 in France) reported having knowledge or good knowledge of those indicators. These data are corroborated by many other results. CONCLUSIONS: Small proportions are aware of those indicators. A good knowledge is associated with being a French pharmacist, working in a teaching hospital or university, having a professional experience of 10 years or more, be involved in a research project, having a scientific watch or having an online profile on database. It appears necessary to inform pharmacists and residents on notoriety indicators.

[Detection and codification of adverse drug reactions in a mother-child university hospital]. / Détection et codification des effets indésirables médicamenteux dans un centre hospitalier universitaire mère-enfant.

INTRODUCTION: In view of the underdeclaration of adverse drug reactions (ADRs), there is a need for optimizing their reporting. To improve our declaration, a pharmacovigilance program was started in 2006 at our center and measures were progressively started (weekly patient rounds, monthly report, etc.). The objectives of the study were to describe and compare the annual average incidence of the ADRs coded by the medical archivists from 1 April 1989 to 31 March 2010 (period 1) and from 1 April 2010 to 31 March 2015 (period 2), to determine the therapeutic classes of drugs associated with ADRs according to age and determine the percentage of ADRs that are declared to Health Canada. METHODS: This was a nonexperimental, descriptive, and retrospective study in a mother-child university hospital. All the ADRs that arose with patients less than 18 years old during period 2 were included. The results of a previous study, conducted during period 1 were used. A Student t-test was used to compare the mean annual incidence and the average number of ADRs per year between the two periods. RESULTS: The average number of ADRs per year was 225.7±65.1 ADRs during period 1 versus 429.6±52.1 ADRs during period 2 (P<0.01). The mean annual incidence of the ADRs was 1.64%±0.41% during period 1 versus 3.17%±0.43% during period 2 (P<0.01). Throughout the study period, the mean annual gravity and mortality index were stable. The ADRs caused by antibiotics/antifungals, anticancer agents, opiates, and corticoids accounted for more than 50% of the total ADRs from 1989-1990 to 2014-2015. Only 37% of the ADRs were declared to Health Canada during period 1 versus 41% during period 2. CONCLUSION: This study highlighted a progressive increase in the codification of the ADRs in the pediatric population from 1989-1990 to 2014-2015. No causal effect could be obtained between the measures that we implemented in 2006 and the improvement seen with the ADR codification, but we can reasonably suspect a positive impact.

Publications presenting negative impacts of pharmacists.

OBJECTIVES: The main objective was to evaluate the rate of publications with at least one indicator of the negative impact of clinical pharmaceutics activity. METHODS: This is a descriptive and retrospective literature review. A literature search was conducted using Pubmed. Articles published between 2009-2014 that described the role and impacts of pharmacists were included. We calculated the rate of publication containing at least one negative indicator. We collected the indicators with negative results. RESULTS: A total of 203 articles were included. Nine articles (4%) that had at least one indicator of negative impact were identified. A total of 66% (6/9) were conducted in the United States. The study designs of the articles included were a meta-analysis (n=1), a systematic review (n=1), randomized studies (n=2), pre-post studies (n=3), a cohort study (n=1) and a survey (n=1). Nine indicators of negative impact were identified. CONCLUSION: There were nine publications with at least one negative indicator of the impact of clinical pharmacy activity. While there are a large number of studies about the positive impact of clinical pharmacy activities; the publication of negative results should be encouraged.

Comparison of Information Available in the Medication Profile of an Electronic Health Record and the Inpatient Best Possible Medication History in a Mother and Child Teaching Hospital Center.

BackgroundMedication reconciliation (MedRec) can improve patient safety. In Canada, most provinces are implementing electronic health records (EHR). The Quebec Health Record (QHR) can theoretically be used for medication reconciliation. However, the quantity and the quality of information available in this EHR have not been studied. ObjectivesThe main objective was to compare the quantity and quality of the information collected between the inpatient best possible medication history (BPMH) and the QHR.   MethodsThis is a descriptive prospective study conducted at CHU Sainte-Justine, a 500-bed tertiary mother-and-child university hospital center. All inpatients from May 19-26, 2015 were considered for inclusion. Every prescription line in the BPMH and QHR were compared. ResultsThe study included 344 patients and 1,039 prescription lines were analyzed. The medications' name and dosing were more often available in the QHR (95%) than in the BPMH (61%). Concordance between the medication names between QHR and BPMH was found in 48% of the prescription lines; this rate fell to 29% when also factoring daily dosage.  ConclusionsThis study suggests that the QHR can provide high-quality information to support the MedRec hospital process. However, it should be used as a second source to optimize the BPMH obtained from a thorough interview with the patient and/or his or her family. More studies are required to confirm the most optimal way to integrate the QHR to the MedRec process in hospitals.

[Pilot study evaluating the ratio of medication errors related to antimicrobials compared to their consumption]. / Étude pilote des erreurs médicamenteuses liées aux anti-infectieux par rapport à leur consommation.

INTRODUCTION: As part of our antimicrobial stewardship program, we were interested in the use of anti-infectious drugs and the prevalence of medication errors associated with the use of these drugs. METHODS: The retrospective and descriptive study was conducted over a 1-year-period between 1 April 2012 and 31 March 2013 in a teaching mother-child hospital. The aim of the study was to determine the number and the type of medication errors related to anti-infectious drugs. We evaluated the importance, the significance, and the severity of medication errors and at the same time we evaluated antimicrobial consumption. Therefore, we determined the ratio of medication errors per 10,000 defined daily doses (DDD) or 10,000 days of therapy (DOT). The secondary objective of the study was to compare the medication errors related to anti-infectious drugs with the data published in the Quebec Registry of Incidents and Accidents. RESULTS: We found a total of 2164 medication errors including 301 (14%) medication errors related to anti-infectious drugs during the 2012-2013 fiscal year. The majority (95%) of the medication errors related to anti-infectious drugs was not harmful, with no consequences for the patient. Seventy-four percent of medication errors related to anti-infectious drugs were part of the C class on the severity scale. Omission (26%) and wrong dose administration were the two most frequently reported events. Eighty percent (n=242/301) of medication errors occurred during the administration step while only 8% (n=24/301) occurred during the prescribing step. Three anti-infectious drugs had the highest ratio of medication errors per 10,000 DDD or DOT: linezolid (376 medication errors per 10,000 DDD), doxycycline (357 medication errors per 10,000 DDD), and acyclovir (202 medication errors per 10,000 DDD). The nonparametric tests showed no significant differences between frequently used and infrequently used anti-infectious drugs for the ratio of medication errors per 10,000 DOT. This pilot study showed a ratio of 65.4 medication errors/10,000 DDD of anti-infectious drugs and a ratio of 41.9 medication errors/10,000 DOT of anti-infectious drugs. CONCLUSION: The use of these ratios could contribute to focusing on monitoring anti-infectious drugs and improving the risk management system associated with this class of drugs. It also shows that less frequently used anti-infectious drugs should be managed with greater caution. Anti-infectious stewardship programs should also consider ratios of medication errors for anti-infectious drugs used in order to improve patient safety and optimize use of drugs.

[Upgrading a pediatric pharmaceutical care service in Quebec]. / Mise à niveau d'un secteur pédiatrique de soins pharmaceutiques au Québec.

INTRODUCTION: Clinical pharmacy has developed since the 1960s in North America, with large disparities in the presence of decentralized pharmacists in hospital units between healthcare programs. Decentralized pharmacists have been present in pediatrics since the 1970s. The main objective of this study was to describe the steps used to upgrade the pediatrics department's pharmaceutical care. METHODS: A descriptive study was conducted to upgrade the pharmaceutical care provided by two full-time equivalents in two pediatric sectors including 81 beds of a tertiary mother-child hospital. The upgrade includes three steps: a structured literature review, a description of the department, and a description of the practice upgrades proposed by the research team, in consensus with the clinical pharmacy team. RESULTS: Out of the 236 articles initially identified, 13 relevant articles were found on the role and impact of pharmacists in pediatrics. Nine pharmaceutical activities were supported by high-quality data. Following the literature review and concerted reflection, 15 improvements were identified as feasible without increasing the staff. CONCLUSION: There are data on the impact of pharmacists in pediatrics. This descriptive study illustrates a method that was used to upgrade the pediatrics sector in a university mother-child health center.

[Assessment of perception about medication reconciliation among healthcare professionals at Saint-Justine hospital]. / Évaluation de la perception des professionnels de santé vis-à-vis du bilan comparatif des médicaments au CHU Sainte-Justine.

OBJECTIVES: Our main objective is to assess nurses and doctors perception about medication reconciliation. METHODS: This is a descriptive and cross-sectional study. We have created three surveys, one for each health worker (nurses, doctors, resident, pharmacists). Each survey consists of single or multi-choice closed questions. A four-point Likert scale was used to collect the perception. Descriptive statistics have been calculated. RESULTS: A total of 114 nurses, 98 doctors and residents and 26 pharmacists from all care services, replied to the survey. The majority of doctors (58%), pharmacists (60%) and nurses (52%) recognized the relevance and utility of medication reconciliation in healthcare safety. However, few healthcare professionals (6% of doctors, 13% of nurses et 46% of pharmacists) know that medication reconciliation is a required organizational practice. Only 25% of doctors always consult the best possible medication history after a patient admission while the majority do not use it because of unreliability issues. So, there have been some major changes to optimize medication reconciliation process in our hospital. CONCLUSION: This study shows a increasing interest to medication reconciliation by healthcare professionals. However, the use of medication reconciliation remains marginal.

[Failure mode and effects analysis (FMEA) of insulin in a mother-child university-affiliated health center]. / Utilisation de l'insuline en établissement de santé universitaire mère-enfant : analyse des modes de défaillance.

CONTEXT AND OBJECTIVES: Insulin is a high-alert drug. The main objective of this descriptive cross-sectional study was to evaluate the risks associated with insulin use in healthcare centers. The secondary objective was to propose corrective measures to reduce the main risks associated with the most critical failure modes in the analysis. METHODS: We conducted a failure mode and effects analysis (FMEA) in obstetrics-gynecology, neonatology and pediatrics. RESULTS: Five multidisciplinary meetings occurred in August 2013. A total of 44 out of 49 failure modes were analyzed. Nine out of 44 (20%) failure modes were deemed critical, with a criticality score ranging from 540 to 720. DISCUSSION: Following the multidisciplinary meetings, everybody agreed that an FMEA was a useful tool to identify failure modes and their relative importance. This approach identified many corrective measures. CONCLUSION: This shared experience increased awareness of safety issues with insulin in our mother-child center. This study identified the main failure modes and associated corrective measures.

[Pilot study evaluating the ratio of adverse drug reactions related to antimicrobials over their consumption in 2012-2013]. / Étude pilote permettant de calculer le ratio d'effets indésirables médicamenteux par 10 000 doses définies journalières et 10 000jours de traitement d'anti-infectieux en 2012-2013.

OBJECTIVES: As part of our antimicrobials stewardship program, we were interested in the use of antimicrobials and prevalence of adverse drug reactions associated with the use of these drugs. METHODS: The retrospective and descriptive study was conducted over a one year-period between April 1st 2012 and March 31st 2013 in a mother-child Hospital. We determined the ratio: number of adverse drug reactions over 10,000 defined daily dose or 10,000days of therapy. We identified the ratios higher than average for which the confidence interval did not cross the calculated average. The severity of the adverse drug reactions was codified using the Common Terminology Criteria for Adverse Events. RESULTS: We found 570 adverse drug reactions including 100 (17.5%) adverse drug reactions related to antimicrobials during the financial year 2012-2013. It represented 96 patients. Thus, five antimicrobials, for which the confidence interval does not cross the calculated average value, may be targeted in risk management because they have a higher ratio than average: piperacillin (290 [113-722]), valganciclovir (244 [43-1260]), ceftriaxone (114 [56-234]), acyclovir (76 [26-220]) and liposomal amphotericin B (72 [20-258]). CONCLUSION: In a mother-child university hospital, we calculated a ratios of 19 [15-23] and 13 [10-15], it allows us targeting some antimicrobials in our approach to prevention and management of adverse drug reactions.

[Hospital pharmacists' perception of pharmacovigilance in Quebec]. / Perception de la pharmacovigilance par les pharmaciens hospitaliers québécois.

OBJECTIVES: To assess the pharmacovigilance perception of Quebec's hospital pharmacists. METHODS: Cross-sectional study. A questionnaire with 16 questions was developed in order to assess respondents' perception of their ability to practice pharmacovigilance, factors that can influence adverse drug reactions reporting and measures to increase reporting rate. The online questionnaire was sent to hospital pharmacist from Quebec in April 2014. The results were presented in the form of descriptive data. RESULTS: A total of 179/252 (71%) hospital pharmacists responded. More than 90% of respondents considered that they were able to practice all activities related to pharmacovigilance. During one year of practice, 98% of respondents faced at least one serious or unexpected adverse drug reaction and 77% notified at least one adverse drug reaction to Health Canada. The factors encouraging more than 89% of respondents to notify were: the severity, the rapidity of onset, the visibility of the reaction, the fact that the adverse drug reaction was unexpected or due to a recent marketed drug. More than 69% of respondents considered the overwork as the principal obstacle to the notification. The majority of respondents supported the implementation of 13/14 measures in order to increase reporting rate. CONCLUSION: Hospital pharmacists from Quebec presented a favorable ability to practice pharmacovigilance. Analysis of their perception of pharmacovigilance helped to identify improvements, such as the implementation of a pharmacovigilance coordinator in the health center.

[A new website with evidence-based pharmaceutical information]. / Presentation d'un nouveau site de donnèes probantes pharmaceutiques.

Aware of the difficult choices that health policy makers face and the desire to develop pharmaceutical care, the Pharmacy Practice Research Unit team from the CHU Sainte-Justine examined evidence about the role and the impact of pharmacists. This research took the form of a structured approach to review the evidence from the literature. A website was designed and programmed to ensure effective knowledge sharing (http://impactpharmacie.org). The site lists evidence of the role and impact of the pharmaceutical activities, in both inpatient and outpatient settings. The site lists twelve articles from Belgian literature for hospital and community practice. Four positive outcomes of pharmaceutical interventions were recorded. This site can help to foster reflection and action surrounding the development of clinical pharmacy in Belgium.

[Review and analysis of the evidence on the role and the impact of pharmacists' activities: Development of an online tool]. / Recensement et analyse des preuves sur le rôle et sur les retombées de l'activité pharmaceutique : développement d'un outil sur Internet.

BACKGROUND: Considering the increase in healthcare expenses, stakeholders need to make choices, including healthcare program funding, and professional activities to prioritise. PURPOSE: The main objective was to list evidences about the role and impact of pharmacists. METHODS: Themes were chosen according to three dimensions of the pharmacist profession: (1) activities, (2) healthcare programs and (3) disorders. A literature search was conducted for each theme. A bibliographic data sheet was completed for each article. An analytic data sheet, consisting of descriptive and impact outcomes, was also completed for the most relevant articles. For each theme, a synthesis was elaborated. The website Impact Pharmacie (http://impactpharmacie.org) was developed. RESULTS: A total of 70 synthesis were written. A total of 1442 articles were included with a bibliographic data sheet, and 914 with an analytic data sheet. Six hundred and fifty articles had positive outcomes on the role of the pharmacist, representing 803 different positive outcome markers. Pharmacists had positive outcomes on morbidity (n=212), adherence (n=92), costs (n=36), adverse effects (n=26), drug errors (n=31) and mortality (n=13). CONCLUSION: This descriptive study presents the review of the evidence on the role and the impact of pharmacists activities, which led to the Impact Pharmacie website. This francophone website can contribute to support clinical pharmacy development, and to a better use of pharmacists in healthcare.

[Steps aimed at upgrading a pharmaceutical care sector: the case of surgery]. / Démarche pour la mise à niveau d'un secteur de soins pharmaceutiques : le cas de la chirurgie pédiatrique.

BACKGROUND: While the concept of clinical pharmacy was developed in the 1960s, clinical programs are characterized by their great variety and disparity when it comes to the presence of pharmacists in healthcare sectors. PURPOSE: This article aims to describe a method in which pharmaceutical care sectors in healthcare facilities can be upgraded. METHODS: This is a descriptive study supporting the upgrade of pharmaceutical care practiced in the surgery sector of a 500-bed mother-child university hospital center, the CHU Sainte-Justine. The pharmacy department employs more than 70 healthcare professionals. The study involved these proposed upgrading steps: firstly, a review of the literature; secondly, a description of the profile of the sector; thirdly, a description of the upgrading of pharmacist practice in surgery. RESULTS: A total of 137 articles were compiled, seven of which were selected to evaluate the impact and eight a description of the pharmacist's role in surgery. The authors did not identify any particular pharmaceutical activity based on very good quality data (A). However, there were five based on good quality data (B) and seven that lacked adequate proof (C, D) in relation to the practice of surgery. Nevertheless, a number of other authors described the development of the pharmacist's clinical role in surgery. CONCLUSION: There are few data on the impact of pharmacists in surgery. This descriptive study proposes a number of steps aimed at upgrading pharmaceutical care within a Quebec university hospital center.