[Securing the distribution of patient-specific unit dose medication following the installation of a unit dose dispensing system: Cartography of risks a priori within a hospital pharmacy]. / Sécurisation de la dispensation individuelle et nominative suite à l'implantation d'un automate de dispensation nominative : cartographie des risques a priori au sein d'une pharmacie à usage intérieur.

INTRODUCTION: With a view to reinforcing the security of the drug distribution process, the hospital pharmacy has decided to automate the patient-specific unit dose distribution system which, up to now was performed manually, through the acquisition of a unit dose dispensing system: the ACCED S 300 (ECODEX®). The aim of this work is to realize a cartography of risks, focused on the dispensing stage, prior to the implementation of the automated system. MATERIALS AND METHOD: A multidisciplinary group applied the preliminary risk analysis (PRA) technique. The study was limited to the dispensing stage of unit doses within the hospital pharmacy. RESULTS: This analysis revealed 122 accident scenarii, including 18 with an initial unacceptable criticality (14.8 % of scenarii). In total, 140 risk management actions were proposed. These actions include: acquisition of equipment, communication and training of pharmacy staff, communication with services, human resources management and organization of working hours, writing and updating quality documents, programming the software and interfaces linked with the robot. CONCLUSION: The implementation of risk management actions should reduce the risk and contribute to avoiding the most critical scenarii. This will require the availability of human and financial resources and the implication of management.

[Security of the medicinal therapy: Cartography of risks a priori within service of orthopaedic surgery]. / Sécurisation de la prise en charge médicamenteuse : cartographie des risques a priori au sein du service de chirurgie orthopédique.

INTRODUCTION: Security and quality of the Medicinal Therapy are one of the most important objectives of the April 6th, 2011 order. The objective is to realize this study of the risks incurred by patients related to management and security of medicinal therapy in order to establish a plan to reduce the risks of drug's dispensation. MATERIALS AND METHOD: The method of the Preliminary Risk Analysis (PRA) has been implemented by a multidisciplinary group in a hospital service of orthopaedic surgery. The study focused on the dispensation phase of medicinal circuit. RESULTS: This analysis revealed 148 scenarii, 35 were criticality unacceptable. Fifty-four initial risk control actions were proposed and their stress levels to put them in place were evaluated. DISCUSSION: The main measures of risk management are: training, information, communication, computerization, automation, dual control, updating the documentation system, drug reconciliation and respect for Best Practices Hospitallers (BPH). CONCLUSIONS: Risk management requires a significant human and financial investment as well as, material resources and multidisciplinary expertise in order to offer the best solutions.