[Treatment of bronchial superinfections: data related to stability of antibiotics in portable pumps]. / Traitement des surinfections bronchiques: stabilité des antibiotiques dans les diffuseurs portatifs.

INTRODUCTION: Given many data about the stability of antibiotics in portable pump (elastomer) are lacking, this study was designed to make a point about available data and to evaluate the stability of antibiotics when exposed to temperature within 35 degrees C (average temperature measured in real conditions of use). MATERIAL AND METHODS: First, to collect information about the stability of antibiotics in portable pump and to confront them with the local antibiotics protocols dedicated to the treatment of bronchial superinfection in patients with cystic fibrosis; second, to evaluate the stability of piperacillin associated with tazobactam at 35 degrees C. RESULTS: While measured concentrations in tazobactam did not show significant variation during the study, piperacillin measurements showed a major reduction of concentration (up to 33%), both time and concentration related to. DISCUSSION: Such information must be pointed out to prescribers and patients to ensure a cold accumulator is placed in the pump carrying-bag and to limit the duration of infusion to 24 h with a single pump. CONCLUSION: This experimental program will keep on going with the stability study of both ticarcillin and cefsulodin in portable pump.

[Not Available]. / Traitement des surinfections bronchiques: stabilité des antibiotiques dans les diffuseurs portatifs.

UNLABELLED: Treatment of Bronchial Superinfections: Data Related to Stability of Antibiotics in Portable Pumps. INTRODUCTION: Given many data about the stability of antibiotics in portable pump (elastomer) are lacking, this study was designed to make a point about available data and to evaluate the stability of antibiotics when exposed to temperature within 35°C (average temperature measured in real conditions of use). MATERIAL AND METHODS: First, to collect information about the stability of antibiotics in portable pump and to confront them with the local antibiotics protocols dedicated to the treatment of bronchial superinfection in patients with cystic fibrosis; second, to evaluate the stability of piperacillin associated with tazobactam at 35°C. RESULTS: While measured concentrations in tazobactam did not show significant variation during the study, piperacillin measurements showed a major reduction of concentration (up to 33%), both time and concentration related to. DISCUSSION: Such information must be pointed out to prescribers and patients to ensure a cold accumulator is placed in the pump can'ying-bag and to limit the duration of infusion to 24h with a single pump. CONCLUSION: This experimental program will keep on going with the stability study of both ticarcillin and cefsulodin in portable pump.

Impact of drug reconciliation at discharge and communication between hospital and community pharmacists on drug-related problems: study protocol for a randomized controlled trial.

BACKGROUND: Patients are at risk of drug-related problems (DRPs) at transition points during hospitalization. The community pharmacist (CP) is often the first healthcare professional patients visit after discharge. CPs lack sufficient information about the patient and so they may be unable to identify problems in medications, which may lead to dispensing the wrong drugs or dosage, and/or giving wrong information. We aim to assess the impact of a complex intervention comprising of medication reconciliation performed at discharge by a hospital pharmacist (HP) with communication between the HP and CP on DRPs during the seven days following discharge. METHODS/DESIGN: The study is a cluster randomized crossover trial involving 46 care units (each unit corresponding to a cluster) in 22 French hospitals during two consecutive 14-day periods, randomly assigned as 'experimental' or 'control' (usual care) periods. We will recruit patients older than 18 years of age and visiting the same CP for at least three months. We will exclude patients with a hospital length of stay of more than 21 days, who do not return home or those in palliative care. During the experimental period, the HP will perform a medications reconciliation that will be communicated to the patient. The HP will inform the patient's CP about the patient's drug therapy (modification in home medication, acute drugs prescribed, nonprescription treatments, and/or lab results). The primary outcome will be a composite outcome of any kind of drug misuse during the seven days following discharge assessed at day seven (±2) post-discharge by a pharmacist in charge of the study who will contact both patients and CPs by phone. The secondary outcome will be unplanned hospitalizations assessed by phone contact at day 35 (±5) after discharge. We plan to recruit 1,176 patients. DISCUSSION: This study will assess the impact of a reconciliation of medications performed at patient discharge followed by communication between the HP and the patient's CP. It will allow for identifying the type of patients in France for which the intervention is most relevant. TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov (number: NCT02006797) on 5 December 2013.

Communication between community and hospital pharmacists: impact on medication reconciliation at admission.

OBJECTIVE: To evaluate the non-intentional prescription discrepancies between home medication and hospital medication for in-patients, their potential clinical impact and the impact of pharmaceutical communication between community pharmacists (CP) and hospital clinical pharmacists (HCP) to prevent them. SETTING: Prospective study of 278 in-patient's files hospitalized in orthopaedic surgery + units. METHODS: After reconciliation by the HCP including patient interviews, GP prescription reviews and CP drug delivery analyses, we analysed patient files (prescription and patient chart) and we compared the administered drugs (home medication) to those that the patient should have received. We tracked the pharmaceutical intervention, the physician acceptance and the identified and avoided errors. The clinical impact of each discrepancy was evaluated by a team composed of a physician and a clinical pharmacist. MAIN OUTCOME MEASURE: Frequency of intentional and non-intentional discrepancy (NID), evaluation of NID clinical impact and rate of NID identified and corrected by the reconciliation procedure. RESULTS: 278 consecutive patients were included in the study. 1,532 prescription lines were analysed and 471 discrepancies were observed [IC95 % = (28.43; 33.00)]. Nonintentional discrepancies (NID) affected 9.2 % of prescription lines [IC95 % = (7.7; 10.6)] and 34.2 % of patients [IC95 % = (31.3; 37.1)]. Fifty-one patients (18.3 %) had at least one NID classified as potentially harmful. Sixty-nine percent of errors at admission were identified by the reconciliation procedure including data exchanges with CP. CONCLUSION: This study demonstrates the importance of drug reconciliation at patient's admission by the HCP supported by communication with the CP.

[Drugs adjustment dosage at hospital discharge for patients with renal failure: study of 326 medical records]. / Prescriptions médicamenteuses à la sortie d'hospitalisation de patients insuffisants rénaux : étude de 326 dossiers.

INTRODUCTION: The objective of our study was to identify the misuse of drugs necessitating an adaptation to renal function and/or contra-indicated in case of renal failure at discharge. DESIGN: We conducted a 2-month retrospective study in a French teaching hospital for all patients with at least a moderate renal impairment (eDFG<60 mL/min/1.73 m(2)) discharge from eight units (medical and surgical) and compared their prescriptions to guidelines. We classified each drug prescription as N: drug that do not need adaptation or non contra-indicated for the renal status of patient; A: drug that need an adaptation to kidney but those was correctly done; I: drug that need an adaptation to kidney, those incorrectly done; C: drug contra-indicated in case of renal failure; D: drug for which it is impossible to conclude without an expertise of the patient file. RESULTS: For patient with eDFG less than 60 mL/min/1.73 m(2), 326 prescriptions corresponding to 2137 drugs were analysed. Misuses concerned 19.0% of patients (n=69). For patient with eDFG less than 30 mL/min/1.73 m(2), 42 prescriptions corresponding to 291 drugs were analysed. Misuses concerned 57.1% of patients (n=24). DISCUSSION/CONCLUSION: The misuse observed at patient's discharge may have consequences in further prescriptions; discharge prescriptions are often considered as "validated" by general practitioners. Improving solution should be offered to prescribers and as well as to pharmacists to manage drug dosage adaptation to renal function.

Are antibiotic drugs well prescribed in case of renal insufficiency? A retrospective study.

Renal insufficiency (RI) is a major complication in hospitalized patients. We aim to determinate if the severity of RI is considered for antibiotic prescriptions. A 10-month retrospective study including all in-patients of an orthopedic surgery department, based on the analysis of antibiotic prescriptions of patients with RI, was set up as follows: identification of patients with RI estimated with Cockcroft formula, classification by severity stage, and analysis of antibiotic prescriptions to be adapted to RI. About 10% of patients had RI. Among them, 54 (32%) received antibiotics (on average, 1.75 drugs per patient). Sixteen (17%) of antibiotic prescriptions required either dose adaptation or therapeutic drug monitoring. In all, only four prescriptions were adapted to renal function. In other cases, antibiotics were prescribed according to protocols for patients with normal renal function. Moreover, therapeutic drug monitoring was only performed for half of required cases and then showed values > ULN three times out of four. Creatinine clearance (CrCl) has been calculated for half of patients with RI. In practice, dosage adjustment of antibiotics is done only for patients with severe RI. Within the framework of the introduction of an electronic prescribing technology and medication order pharmaceutical review procedures, CrCl is now systematically calculated and then taken into account by both prescribers and clinical pharmacists.