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2.
BMJ Open ; 11(10): e045778, 2021 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635512

RESUMO

OBJECTIVES: Computerised physician order entry (CPOE) systems facilitate the review of medication orders by pharmacists. Reports have emerged that show conception flaws or the misuse of CPOE systems generate prescribing errors. We aimed to characterise pharmacist interventions (PIs) triggered by prescribing errors identified as system-related errors (PISREs) in French hospitals. DESIGN: This was a cross-sectional observational study based on PIs prospectively documented in the Act-IP observatory database from January 2014 to December 2018. SETTING: PISREs from 319 French computerised healthcare facilities were analysed. PARTICIPANTS: Among the 319 French hospitals, 232 (72.7%) performed SRE interventions, involving 652 (51%) pharmacists. RESULTS: Among the 331 678 PIs recorded, 27 058 were qualified as due to SREs (8.2%). The main drug-related problems associated with PISREs were supratherapeutic (27.5%) and subtherapeutic dosage (17.2%), non-conformity with guidelines/contraindications (22.4%) and improper administration (17.9%). The PI prescriber acceptation rate was 78.9% for SREs vs 67.6% for other types of errors. The PISRE ratio was estimated relative to the total number of PIs. Concerning the certification status of CPOE systems, the PISRE ratio was 9.4% for non-certified systems vs 5.5% for certified systems (p<0.001). The PISRE ratio for senior pharmacists was 9.2% and that for pharmacy residents 5.4% (p<0.001). Concerning prescriptions made by graduate prescribers and those made by residents, the PISRE ratio was 8.4% and 7.8%, respectively (p<0.001). CONCLUSION: Computer-related prescribing errors are common. The PI acceptance rate by prescribers was higher than that observed for PIs that were not CPOE related. This suggests that physicians consider the potential clinical consequences of SREs for patients to be more frequently serious than interventions unrelated to CPOE. CPOE medication review requires continual pharmacist diligence to catch these errors. The significantly lower PISRE ratio for certified software should prompt patient safety agencies to undertake studies to identify the safest software and discard software that is potentially dangerous.


Assuntos
Sistemas de Registro de Ordens Médicas , Estudos Transversais , Prescrições de Medicamentos , Hospitais , Humanos , Erros de Medicação , Farmacêuticos
3.
Eur J Hosp Pharm ; 28(4): 193-200, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33883205

RESUMO

OBJECTIVES: Clinical pharmacists' interventions (PIs) are an important element in ensuring good pharmaceutical care. We aimed to develop and validate a comprehensive multidimensional tool for assessing the potential impact of PIs for daily practice of medication review. METHODS: Experts of the French Society of Clinical Pharmacy (SFPC) developed the CLinical, Economic and Organisational (CLEO) tool, consisting of three independent dimensions concerning clinical, economic and organisational impact. They were asked to analyse 30 scenarios of PIs, and re-rated 10 PIs with a washout of 1 month (internal validation). Then, seven external experts not involved in the development of the tool rated 60 scenarios collected when using the CLEO in daily practice. Inter- and intra-rater reliabilities were determined by calculation of the intra-class correlation (ICCA,1). Users' satisfaction and acceptability of the tool were assessed on a 7-level Likert scale with a 17-item questionnaire. RESULTS: For internal reliability, the inter-rater reliability for the CLEO tool was good for clinical dimensions (ICCA,1=0.693), excellent for economic dimensions (ICCA,1=0.815) and fair for organisational dimensions (ICCA,1=0.421); and the intra-rater reliability was good for clinical dimensions (ICCA,1=0.822), excellent for economic dimensions (ICCA,1=0.918) and good for organisational dimensions (ICCA,1=0.738). For external reliability, the inter-rater reliability was good for clinical dimensions (ICCA,1=0.649), excellent for economic dimensions (ICCA,1=0.814) and fair for organisational dimensions (ICCA,1=0.500). CLEO was viewed as relevant (mean±SD 4.93±1.27), acceptable (4.81±1.78), practicable (5.56±1.45) and precise (5.38±1.47). CONCLUSIONS: CLEO is a comprehensive tool assessing clinical, economic and organisational impacts of PIs which has been developed, validated and was reliable and feasible for use in routine clinical practice.

4.
J Clin Pharm Ther ; 46(4): 1041-1045, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33629438

RESUMO

WHAT IS KNOWN AND OBJECTIVE: Proton pump inhibitors (PPI) have become essential in the management of upper gastrointestinal disorders, yet they are prescribed without an indication in up to 89% of cases and the number of prescribed PPIs is on the rise. A working group developed several multifaceted strategies in our multihospital trust to curb inappropriate PPI use. We describe herein these strategies and assess their impact on PPI consumption in a hospital belonging to this trust. METHODS: From 2012 to 2019, our actions included the publication and presentation of a review of emergent PPI side effects, the development of an appropriate use leaflet, medication audits, journal club meetings, and prescription analysis. We considered that a decrease in PPI consumption could be a relevant surrogate criterion for the appropriation and acceptance of these interventions; this was assessed from 2012 to 2019 and expressed as defined daily dose (DDD)/1000 patient-days. RESULTS AND DISCUSSION: There was a clear downward trend in the consumption of PPIs, both in medical and surgical wards. The overall PPI use decreased by 17.1% (from 566 to 468 DDD/1000 patient-days). IV PPI consumption dropped by 37.7% (from 146 to 91 DDD/1000 patient-days), while oral PPIs consumption decreased by 10% (from 420 to 378 DDD/1000 patient-days). WHAT IS NEW AND CONCLUSION: Sustained strategies aimed at curbing PPI overprescribing led to a sustained decrease in PPI consumption in our hospital. This decrease encourages us to pursue this strategy and to diversify our actions.

5.
Rech Soins Infirm ; (141): 78-86, 2020 06.
Artigo em Francês | MEDLINE | ID: mdl-32988194

RESUMO

Despite its proven dangers, the ward stock drug distribution system predominates in French hospitals. This system allows 12 million injectable ampoules of concentrated potassium chloride to circulate uncontrolled each year. Such a situation is absurd for the following reasons : 1) injected by mistake, concentrated potassium kills within seconds ; 2) the true incidence of potassium-related fatalities and incidents is unknown ; 3) fatal intravenous injection of potassium produces no specific anatomical changes and subtle, if any, findings at autopsy ; 4) it is used for capital punishment by lethal injection in various countries ; and 5) healthcare worker serial killers benefit from the fact that potassium is not identifiable in post-mortem examinations and that investigations to find the murderer are complex and of uncertain outcome. Other medications classed as high-risk have similar characteristics to those of concentrated potassium solutions. Injectable potassium can therefore be regarded as emblematic of the lack of safety of the drug use process in French hospitals. The priority measure to protect patients from this deadly risk is to remove these drugs from uncontrolled ward stocks and to provide premixed potassium solutions. Evidence of the increased safety of the unit dose drug dispensing system should compel health policy makers to systematically implement it, thus bringing the drug use process into compliance with existing French and European regulations.


Assuntos
Segurança do Paciente/normas , Cloreto de Potássio/envenenamento , Controle de Medicamentos e Entorpecentes , França , Hospitais , Humanos , Injeções , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/química
6.
Clin Drug Investig ; 40(10): 897-899, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32779119

RESUMO

During the ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more attention should be paid to the balance of risks and benefits associated with proton pump inhibitors for the following reasons. One of the main functions of gastric juice is to inactivate swallowed microorganisms, thereby inhibiting infectious agents from reaching the intestine. Studies have documented that proton pump inhibitors are a risk factor for rotavirus, influenza virus, norovirus, and Middle East respiratory syndrome coronavirus infections, and are associated with an increased risk of acute gastroenteritis during periods of highest circulation of enteric viruses. In light of the evidence for gastrointestinal infection implying a fecal-oral transmission of SARS-CoV-2 and given the magnitude of the SARS-CoV-2/coronavirus disease 2019 pandemic, associated with the widespread misuse of proton pump inhibitors, this suggests that we should not rule out the hypothesis that patients treated with proton pump inhibitors may be more at risk of being infected by SARS-CoV-2.


Assuntos
Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Inibidores da Bomba de Prótons/efeitos adversos , Betacoronavirus/fisiologia , COVID-19 , Infecções por Coronavirus/induzido quimicamente , Ácido Gástrico/fisiologia , Humanos , Coronavírus da Síndrome Respiratória do Oriente Médio/efeitos dos fármacos , Coronavírus da Síndrome Respiratória do Oriente Médio/fisiologia , Pandemias , Pneumonia Viral/induzido quimicamente , Fatores de Risco , SARS-CoV-2
8.
Soins ; 63(827): 10-14, 2018.
Artigo em Francês | MEDLINE | ID: mdl-30008357

RESUMO

The packaging of the medication and the writing on the label can be the cause of medication errors. Errors in the intake of sodium chloride and potassium chloride have notably been due to the fact that the label of the infusion solute did not explicitly indicate the quantities present in the 500 mL and 1 000 mL bottles. Moreover, the meaning of the description comprising the term 'q.s.p. 1 000 mL' was not known by some of the nursing staff. These two factors, combined with the possibility of prescribing predefined order sets, have led to medication errors which have given rise to a study of how practices can be improved.


Assuntos
Sistemas de Registro de Ordens Médicas , Erros de Medicação/prevenção & controle , Rotulagem de Medicamentos , França , Humanos , Segurança do Paciente
10.
Res Social Adm Pharm ; 13(6): 1184-1185, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-27888092

RESUMO

Over the past 25 years in various countries, researchers have developed tools for recording pharmacist's interventions (PIs) and observational databases aimed at the exhaustive collection of these interventions. The large amount of published data contrasts strikingly with the fact that little attention has been paid to defining the different types of PIs from a theoretical point of view. Whatever the paper we read on this topic, each PI is presented as necessary and appropriate. We suggest this customary approach is biased and that the reality is somewhat more subtle. In order to better reflect the real world, we propose a new approach to the classification of PIs that is based on whether they are present or absent in observational databases, and we explain how to identify the absent ones. Present and absent PIs can be subdivided in two additional categories: appropriate and inappropriate ones. This additional classification should encourage pharmacists to critically examine and evaluate their practice and subsequently improve their ability to identify drug related problems in clinical practice.


Assuntos
Documentação/classificação , Farmacêuticos/organização & administração , Papel Profissional , Bases de Dados Factuais , Humanos
11.
Transplantation ; 100(12): 2671-2681, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27547868

RESUMO

BACKGROUND: Doppler ultrasound (DUS) arterial abnormalities (DAA) after orthotopic liver transplantation (OLT) often represent a sign of hepatic artery (HA) complication (HAC). The standard management of DAA involves computed tomographic angiography (CTA) followed by invasive vascular intervention (IVI) or observation. We evaluated the contribution of systemic vasodilators (SVD) to the management of DAA after OLT. METHODS: Between 2005 and 2015, 91 of 514 OLT recipients developed DAA (defined by HA resistive index [HARI] <0.5) and received oral SVDs. Doppler ultrasound was performed 2 days later, and patients were assigned to 3 groups accordingly: the normalization group (HARI >0.5), improvement group (HARI increase of >0.1 but value <0.5), or nonresponse group. We analyzed the contribution of this strategy to predict clinically significant HAC, defined as thrombosis or HAC requiring IVI. RESULTS: A clinically significant HAC (4 thromboses, 35 HACs requiring IVI) was found in 2.9% (n = 1/34), 32.1% (n = 9/28), and 100% (n = 29/29) of patients in the normalization, improvement, and nonresponse groups, respectively (P < 0.001). On multivariate analysis, absence of HARI normalization after SVD and time to DAA longer than 30 days were associated with clinically significant HAC. Specificity and accuracy of DUS after SVD increased from 88.1% to 95.1% and from 88.9% to 95.1% (P < 0.001), without altering its sensitivity (97.7% vs 95.5%, P = 1.000). CONCLUSIONS: The use of SVD improves the diagnostic performance of DUS for clinically significant HAC after OLT. It allows identifying patients at low risk for HAC, for whom CTA could be avoided, and helps choosing between observation and IVI in patients with inconclusive CTA.


Assuntos
Falência Hepática/diagnóstico por imagem , Falência Hepática/cirurgia , Transplante de Fígado , Vasodilatadores/uso terapêutico , Adulto , Anastomose Cirúrgica , Angiografia , Artérias/patologia , Angiografia por Tomografia Computadorizada , Feminino , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Trombose/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia Doppler , Doenças Vasculares/diagnóstico por imagem
13.
Pediatr Infect Dis J ; 35(6): 634-8, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26906163

RESUMO

BACKGROUND: The treatment of newborns and infants with congenital toxoplasmosis is standard practice. Some observational studies have examined safety in newborns, but most of these failed to provide sufficient details for a provisional assessment of causality. The aim of this study was to evaluate the clinical and biological adverse effects of the combination of sulfadoxine-pyrimethamine. METHODS: Sixty-five children treated for 1 year with a combination of sulfadoxine-pyrimethamine (1 dose every 10 days) for congenital toxoplasmosis were followed up to evaluate abnormal hematological values and potential adverse events using a standardized method of causality assessment. RESULTS: Nine patients (13.8%) presented at least 1 adverse clinical event that was nonspecific, such as diarrhea on the day of drug administration, vomiting and agitation. In 1 patient, erythema appeared at the end of the treatment and resolved within 10 days. None of these events was attributed to the treatment. Six patients (9.2%) developed an adverse hematological event (neutropenia, n = 3; eosinophilia, n = 2 and both anemia and eosinophilia, n = 1) that was considered to be possibly related to the sulfadoxine-pyrimethamine combination. Four treatments were temporarily interrupted, and toxicity was observed after readministration of treatment in 1 case only. However, none of these adverse events was life threatening. CONCLUSIONS: According to our results and previously published data, the combination of sulfadoxine-pyrimethamine seems to be well tolerated. However, the sample size of our study was too small to rule out the risk of less frequent, but nevertheless severe, reactions and, in particular, of hypersensitivity reactions.


Assuntos
Antimaláricos/efeitos adversos , Antimaláricos/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Pirimetamina/efeitos adversos , Pirimetamina/uso terapêutico , Sulfadoxina/efeitos adversos , Sulfadoxina/uso terapêutico , Toxoplasmose Congênita/tratamento farmacológico , Causalidade , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos
14.
Drug Saf ; 39(2): 131-46, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26650064

RESUMO

INTRODUCTION: Assessing the significance of pharmacist interventions (PIs) is essential to demonstrate the added value of pharmacists. Methods and tools for assessing the potential significance of PIs are diverse and their properties are questionable. OBJECTIVES: We aimed to systematically review the tools available to assess the potential significance of PIs. METHODS: We conducted a systematic search for English- or French-language publications from 1986 to 2013 in PubMed, PsycINFO, PASCAL, and CINAHL. Studies were screened by two independent reviewers based on inclusion/exclusion criteria and were abstracted for content, structure of tools, and validation process. RESULTS: Of 873 citations screened, 82 distinct tools were identified from 133 studies. While clinical aspects were often defined quite clearly, terminology regarding humanistic, economic, and process-related aspects of PIs was omitted, incomplete, or ambiguous in most tools. The probabilities of consequences of PIs/drug-related problems were evaluated in 20/82 tools. Few tools simultaneously measured economic, clinical, humanistic, and process-related variables. Structure of the tools varied from an implicit, mono-dimensional tool to an explicit, multi-dimensional algorithm. Validation processes were diverse in terms of quantification and number of raters, rating method, and psychometric parameters. Of 133 identified studies, there was limited evidence of validity (8/133, 6.0%), inter-rater reliability (49/133, 36.8%), and intra-rater reliability (2/133, 1.5%). CONCLUSIONS: The majority of tools focused primarily on assessing clinical aspects and failed to detect comprehensive impacts. The heterogeneity of tools and assessment processes hindered our ability to synthesize the results of evaluations. Limited results for their validity and reliability cast doubt on the credibility of this methodology for justification of the value of PIs. Recommendations for development of tools with optimal theoretical, pragmatic, and psychometric properties are proposed.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Farmacêuticos/estatística & dados numéricos , Papel Profissional , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Humanos , Modelos Teóricos , Educação de Pacientes como Assunto , Segurança do Paciente , Farmacêuticos/economia , Farmacêuticos/psicologia , Papel Profissional/psicologia
15.
Presse Med ; 44(11): 1162-8, 2015 Nov.
Artigo em Francês | MEDLINE | ID: mdl-26358672

RESUMO

Surgery modifying digestive tract may alter drugs pharmacokinetics. To maintain concentrations of active substance in their therapeutic ranges, a dosage adjustment or change of drug may be necessary. This is particularly important when no pharmacological or pharmacodynamic parameter reflecting the medication effectiveness is easily measurable. Our objective was to gather the information and documentary tools that can guide prescription in these patients with rearranged digestive tract. We searched information on the documentary portals of French agencies, on gray literature, on MEDLINE and in the summaries product characteristics. No information was found on the website of French agencies, sparse data were identified in gray literature. Some document are discordant, most are imprecise. One hundred and ten studies or case reports referenced on MEDLINE describe 79 medications pharmacokinetics after gastrointestinal surgery. Four are not available in France. Six literature reviews were found. Four summaries of product characteristics provided information related to drug absorption. No documentary tool adapted to clinical routine exists. This unsatisfactory situation is a barrier to optimal patients care. Information is available. It is however necessary to gather under an ergonomic shape adapted to clinical routine, bringing the surgery type, pharmacokinetic changes induced and what to do about the dose adjustment.


Assuntos
Cirurgia Bariátrica , Procedimentos Cirúrgicos do Sistema Digestório , Farmacocinética , Estomas Cirúrgicos , Administração Oral , Cirurgia Bariátrica/efeitos adversos , Química Farmacêutica , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Humanos , Absorção Intestinal , Mucosa Intestinal/metabolismo , Intestinos/cirurgia , Preparações Farmacêuticas/administração & dosagem , Síndrome do Intestino Curto/metabolismo
17.
Clin Pharmacokinet ; 53(6): 521-32, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24861189

RESUMO

Kidney disease not only alters the renal elimination but also the non-renal disposition of drugs that are metabolized by the liver. Indeed, modifications in the expression and activity of intestinal and hepatic drug metabolism enzymes and uptake and efflux transporters have been reported. Accumulated uremic toxins, inflammatory cytokines, and parathyroid hormones may modulate these proteins either directly or by inhibiting gene expression. This can lead to important unintended variations in exposure and response when drugs are administered without dose adjustment for reduced renal function. This review summarizes our current understanding of non-renal clearance in circumstances of chronic and acute renal failure with experimental but also clinical studies. It also evaluates the clinical impact on drug disposition. Predicting the extent of the drug disposition modification is difficult first because of the complex interplay between metabolic enzymes and transport proteins but also because of the differential effects in the different organs (liver, intestines). Recommendations of the US FDA are presented as they may be potentially helpful tools to predict these modifications when no specific pharmacokinetic studies are available.


Assuntos
Injúria Renal Aguda/fisiopatologia , Falência Renal Crônica/fisiopatologia , Farmacocinética , Animais , Proteínas de Transporte/metabolismo , Humanos , Mucosa Intestinal/metabolismo , Intestinos/enzimologia , Fígado/enzimologia , Fígado/metabolismo
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