Assessment of adherence to at-home oral anti-infective therapy among paediatric patients discharged from a Quebec hospital.

OBJECTIVES: Non-adherence to anti-infective therapy contributes to treatment failure and the emergence of bacterial resistance. This study aimed to assess at-home adherence, by paediatric patients, to oral anti-infective (OAI) therapy prescribed for treatment of acute infections and to explore the factors contributing to non-adherence. METHODS: This prospective descriptive study involved French-speaking patients under 16 years of age who were discharged with one or more OAIs prescribed for home administration for a maximum of 30 days. Telephone surveys were used to assess overall adherence, which consisted of primary adherence (patient's ability to procure the medication) and secondary adherence (patient's ability to take the treatment as prescribed). RESULTS: Overall, 51.7% (30/58) of patients were adherent to OAI therapy, with 100% primary adherence (n=69/69) and 51.7% secondary adherence (n=30/58). On average, patients took 98% of the total number of doses prescribed, and non-adherence was related mostly to not following medication administration schedules (63.3% of patients followed the exact schedule). Indeed, the adherence rate for patients taking one or two doses per day was twice the rate for patients taking more than two doses per day (81.8% vs 44.7%, p=0.043). CONCLUSIONS: Half of the paediatric patients treated for acute infections were non-adherent to OAI therapy at home. Interventions are needed to improve this situation.

Conformité du circuit du médicament dans les unités de soins et les cliniques externes : étude observationnelle transversale au sein d'un établissement universitaire de 500 lits.

BACKGROUND: In the hospital setting, the medication-use system is complex, having more than 50 steps. To assess the compliance of the study organization's medication-use system with established criteria, an annual audit process was developed. OBJECTIVES: The primary objective was to describe the compliance of certain steps in the medication-use system (mainly medication management) in care units and outpatient clinics of a mother and child university hospital centre. The secondary objective was to compare the current results with those of previous audits. METHODS: This cross-sectional descriptive observational study was carried out in summer 2018 in patient care units (n = 34) and outpatient clinics (n = 28) of the study hospital. Data were collected according to an audit matrix. RESULTS: In 2018, the rate of compliance with audit criteria varied between 32% and 100% for the patient care units. Relative to the previous year, the compliance rate remained unchanged for 30 criteria and worsened for 4 criteria. For 35% of the criteria (12/34), compliance was greater than 85%. In 2018, the rate of compliance with audit criteria varied between 0% and 100% for the outpatient clinics. The compliance rate increased for one criterion, remained unchanged for 21 criteria, and worsened for 2 criteria. For 32% of the criteria (9/28), compliance was more than 85%. Thirty-five recommendations were made to the pharmacy and nursing care committee, and a personalized report was sent to managers. CONCLUSIONS: This cross-sectional descriptive observational study reports the degree to which the medication-use system complies with medication management criteria, mainly in patient care units and outpatients' clinics. This original approach from the Pharmacy Department led to the formulation of 35 recommendations to the pharmacy and nursing care committee, which helped to improve the safety of the medication-use system in patient care units and outpatient clinics.

Impact of adverse drug reactions on the coding of a hospital stay in Quebec: exploratory descriptive study by simulation.

The discharge summary sheet's coding allows calculation of the severity index (SI), mortality index (MI), and resource intensity weight (RIW). These indicators help to describe the burden of care for individual cases and could potentially influence patient-based funding. This study was undertaken to simulate the impact of different adverse drug reactions (ADRs) on the hospital length of stay, thus allowing calculation of the effect of ADRs on the SI, MI, and RIW. This exploratory descriptive study was based on computer simulations. We created, by simulation, seven patient profiles of various complexities representative of our patients. Fifteen types of combination of drug and ADR manifestation comprising 15 ADR caused by eight different drug classes were identified based on the most frequently coded ADR in fiscal years 2016-2017 and 2017-2018. Those 15 combinations were applied to the patient profile to simulate the impact on the SI, MI, and RIW in eight scenarios. From these data, we measured the impact of the ADRs on these indicators. A total of 1,571 simulations were run. In general, the addition of a couple of drug and ADR manifestation contributed to increases in all three of the indicators. More specifically, the SI and RIW both increased in 30.7% (n = 482), whereas the MI increased in 14.6% (n = 229). For a same scenario, the impact on the three indicators could vary depending on the patient profile to which it was applied. This study has presented simulation data on the impact of the coding of ADRs on the hospital stay of a patient in Quebec.

PREPARING FOR VANESSA'S LAW: COLLABORATION BETWEEN THE MEDICAL RECORDS AND PHARMACY DEPARTMENTS AT A CANADIAN HOSPITAL CENTER.

BACKGROUND AND OBJECTIVE: In the context of Vanessa's Law, the medical records department and the pharmacy team of a mother-child hospital collaborated to create a system for coding adverse drug reactions (ADRs). This study was conducted to validate the coding of ADRs by the medical records team. MATERIAL AND METHODS: This retrospective descriptive study covered 12 months of coding of hospitalization data by the medical records team (November 1, 2017, to October 31, 2018). The pharmacy team performed twice-monthly analysis to validate the ADR data, based on coded information for drugs and associated clinical manifestations. RESULTS: Over the 12-month study period, a total of 755 ADRs were coded by the medical records department (i.e., 2.1 ADRs per day, corresponding to 7.1% of admissions). For 34 (4.5%) of these ADRs, the pharmacy team made a change to the code originally assigned by the medical records department. Eighty-five (11.5%) of the coded ADRs were deemed serious, as defined by Health Canada, but only 13 (15%) of these serious ADRs were reported to the regulatory authority. The new process allowed clinical manifestation codes to be associated with individual drugs in the pharmacy's Med-Echo-Plus® software, which facilitated interpretation of the data. Following this study, coding practices were reviewed, a coding algorithm was developed, and the codes for 18 drugs were clarified. CONCLUSION: This study highlights the feasibility of establishing a link between the medical records and pharmacy departments to validate the coding of ADRs. At the study hospital, this linkage has identified serious ADRs, for which reporting will soon be required by Health Canada.

Pediatric SJS/TEN Subdued by a Combination of Dexamethasone, Cyclosporine, and Etanercept.

We report a case of an 17-year-old male with a drug reaction in the spectrum of Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), triggered by carbamazepine, who was succesfully treated with the combination of dexamethasone, cyclosporine, and etanercept. This triple therapy halted and prevented skin epidermolysis without immediate or late onset complications.

Determination of good pharmacovigilance reporting practices in Quebec hospital pharmacies using a modified Delphi method.

PURPOSE: Many published guidelines are available for health care providers describing the best way to manage patient's adverse drug reactions (ADRs). However, there is a lack of guidance on the best way to promote and manage ADR reporting within hospitals. The goal of this study was to develop good pharmacovigilance reporting practices (GPRPs). METHODS: This descriptive study used a modified Delphi method. The research team developed 41 statements, according to a modified Specific Measurable Attainable Realistic Timely (SMART) method and grouped them in six categories: organization (n = 12 statements), pharmacovigilance committee (n = 4), database (n = 5), training (n = 5), tools (n = 3), and quality (n = 12). The Delphi consultation (two online rounds, conducted in 2018) involved directors of pharmacy in Quebec hospitals. RESULTS: Of 30 directors of pharmacy invited to participate in the first round, 27 (90%) did so. Following this round, the wording of five statements was modified according to pre-established rules. Twenty-five (93%) of the original 27 participants responded during the second round. Of the initial 41 statements, 37 were selected (average score ≥ 7); the other four were eliminated. Of the 37 statements selected, 22 had a "must do" formulation, 12 had a "should do" formulation, and three had a "may do" formulation. CONCLUSION: Using a modified Delphi method, we established a set of GPRPs for hospital pharmacy based on 37 statements. To our knowledge, these are the first GPRPs published in the hospital pharmacy literature.