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Medication iatrogenia is a real public health problem. Elderly people are particularly at risk, due to their multiple pathologies, including heart failure; residents of residential care facilities for the dependent elderly (Ehpad) are no exception. Studies show that this risk is avoidable in 60% of cases, and that advanced practice nurses (APNs) can play a pivotal role in preventive measures. How would the role of the APN be perceived by other healthcare professionals working with these heart failure patients institutionalized in Ehpad?, (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

In accordance with the recommendations of the HPST law of 21st July 2009, the retail pharmacists heavily put a lot into new missions, concerning as well prevention and screening as therapeutic education of patient. In that context, two types of pharmaceutical conversations relative to patient's therapeutic training were primarily planned : the first one concerns patients with thrombosis' risk treated by oral anticoagulants (antivitamin K or direct oral anticoagulant), whereas the second one is intended to asthmatics cured by corticoids' inhalation. Then the publication in 2017 and 2018 respectively of amendments no 11 et 12 to the National convention of 4th April 2012 organizing relationships between titular pharmacists and health insurance planned a third type of support called « shared checkup of medication ». It is a matter of program of personalized pharmaceutical monitoring intended to patients at least 65 years old and suffering from one or several long-lasting affection(s), and also to patients at least 75 years old and chronically treated by at least five different active substances. Those new pharmaceutical conversations aim on the one hand to improve observance of chronic medications - current by elderly patients - and on the other hand to prevent drug iatrogenesis - favored by polymedication - while reasserting the major role of the retail pharmacist as health professional., (Copyright © 2019 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Background: Medication errors are the most frequent medical care adverse events in France. Their management process used in hospital remains poorly applied in primary ambulatory care., Objectives: The main objective of our study was to assess medication error management in general ambulatory practice. The secondary objectives were the characterization of the errors and the analysis of their root causes in order to implement corrective measures., Methods: The study was performed in a pluriprofessionnal health care house, applying the stages and tools validated by the French high health authority, that we previously adapted to ambulatory medical cares., Results: During the 3 months study 4712 medical consultations were performed and we collected 64 medication errors. Most of affected patients were at the extreme ages of life (9,4 % before 9 years and 64 % after 70 years). Medication errors occurred at home in 39,1 % of cases, at pluriprofessionnal health care house (25,0 %) or at drugstore (17,2 %). They led to serious clinical consequences (classified as major, critical or catastrophic) in 17,2 % of cases. Drug induced adverse effects occurred in 5 patients, 3 of them needing hospitalization (1 patient recovered, 1 displayed sequelae and 1 died). In more than half of cases, the errors occurred at prescribing stage. The most frequent type of errors was the use of a wrong drug, different from that indicated for the patient (37,5 %) and poor treatment adherence (18,75 %). The systemic reported causes were a care process dysfunction (in coordination or procedure), the health care action context (patient home, not planned act, professional overwork), human factors such as patient and professional condition. The professional team adherence to the study was excellent., Conclusion: Our study demonstrates, for the first time in France, that medication errors management in ambulatory general medical care can be implemented in a pluriprofessionnal health care house with two conditions: the presence of a trained team coordinator, and the use of validated adapted and simple processes and tools. This study also shows that medications errors in general practice are specific of the care process organization. We identified vulnerable points, as transferring and communication between home and care facilities or conversely, medical coordination and involvement of the patient himself in his care., (Copyright © 2018 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Background and Objective: Iatrogenic tracheal injury (ITI) is a rare yet severe complication of endotracheal tube (ETT) placement or tracheostomy. ITI is suspected in patients with clinical and/or radiographic signs or inefficient mechanical ventilation (MV) following these procedures. Bronchoscopy is used to establish a definitive diagnosis., Methods: We conducted a retrospective, single-centre chart review of 35 patients between 2004 and 2014. Depending on the nature and location of ITI and need for MV, patients were triaged to surgical repair, endoscopic management with airway stents or conservative treatment consisting of ETT or tracheotomy cannula (TC) placement distal to the wound and bronchoscopic surveillance., Results: Three of the four patients (11.43%) presenting with tracheoesophageal fistula (TEF) underwent surgery. Seven patients (20%) who did not require MV underwent endoscopic surveillance. Of the 24 ventilated patients (68.57%), 7 with ITI in the lower trachea were treated with silicone Y-stent (ETT or TC was placed inside the stent) and 17 patients with ITI in the upper trachea were managed by placing ETT or TC cuff distal to the injury. Overall management success, defined as complete healing of the ITI, was seen in 88.57% of patients. Four patients (11.43%) died of non-ITI-related comorbidities., Conclusion: Conservative management should be considered in non-ventilated patients with ITI and when ITI is located in the upper trachea of ventilated patients where ETT or TC bypasses the injury. Airway stenting should be considered in ventilated patients with ITI located in the lower trachea. Surgery should be reserved for TEF and conservative and endoscopic management failure., (© 2016 Asian Pacific Society of Respirology.)

Background: In older patients, hospitalization is often associated with new or worsening disability. This hospitalization-associated disability may be explained in part by the cumulative effect of aging, frailty, comorbidities, and illnesses that led to hospitalization but may also result from health care management issues and the hospital environment. Our objective was to determine the frequency, causes, and the preventability of disability induced by the processes of care or "iatrogenic disability.", Methods: A total of 503 patients, aged 75 years and older, hospitalized in the 105 medical and surgical units of Toulouse University Hospital between October 2011 and March 2012, with a minimal length of stay of 2 days, were included. Hospitalization-associated disability was defined as a loss of 0.5 points or more in the Katz Activity of Daily Living Score between the time of hospital admission and discharge. To determine the iatrogenic component of hospitalization-associated disability, an expert panel in geriatric medicine reviewed each medical chart using a standardized record review and identified precipitating iatrogenic adverse events resulting in functional decline., Results: Incidence of iatrogenic disability was 11.9% (95% confidence interval, 9.2%-15.1%). Of the 60 cases of iatrogenic disability, 49 (81.7%, 95% confidence interval, 69.6%-90.5%) were judged to be potentially preventable. The most common health management issues identified in patients with preventable iatrogenic disability were low mobilization [by excessive bed rest (26.5%) and lack of physical therapist intervention (55.1%)], overuse of diapers (49.0%), and transurethral urinary catheterization (30.6%)., Conclusions: The present study suggests that a significant proportion of hospitalization-associated disability may be induced by iatrogenic events, and that most of them are potentially preventable. Health care professionals need to be educated on the specific needs of elderly hospitalized patients and should consider hospitalization-associated disability as an outcome of care., (Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Unlabelled: A morbidity and mortality conference (MMC) is a collective analysis, retrospective and systemic cases marked by occurrence of death, complication, or event that could cause harm to patient (adverse event)., Objectives: Its aim is the implementation and monitoring of actions to improve the care of patients and patient safety. A group for analysis of adverse events in general practice was created in 2011 in the Rhone-Alps, in order to test the feasibility of a MMC with general practitioners (GPs)., Method: A charter setting out the ethical framework and the terminology, methodology and the role of individual players was drafted. Then a group of volunteers was created among the members of an association of continuing medical education. Each session has been the subject of a report. The evaluation was conducted through interviews with participants, and with an electronic survey of satisfaction., Results: Since 2011, 12 physicians participated, analysing 36 cases during seven sessions. Reported events were most frequently interested women with a mean age of patients being 48 years (median 46 years). The situations reported were mixed (error diagnostic, therapeutic, adverse drug). Failures are related to care protocols, decision-making, the care environment (frequent disruptive pop) and human factors (caregiver stress). The participants were satisfied with the initiative. Analyses revealed some redundant causes that can be corrected to secure care. Beyond the non-stigmatising approach it may allow doctors to discuss their feelings without making them feel guilty (concept of second victim)., Conclusion: If such initiatives are still not widespread in ambulatory, they should be promoted by organizations. Openness to other caregivers in Ambulatory is a fundamental change desired by the GP. The National Programme for Patient Safety recently published in February 2013 mentions these aspects, emphasizing the key role of the DPC for acquisition techniques analysis of the causes by caregivers., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: Drug-related problems (DRPs) are common in chronic kidney disease (CKD) patients. We developed a 2-step consultation including a clinical pharmacist (CP) session and a nephrologist conventional care consultation to explore the feasibility of a pilot drug-oriented disease management program in controlling iatrogenic side effects., Methods: Drug inventory was estimated by a CP before each nephrology consultation. CP interventions were based on the French Society of Clinical Pharmacy intervention tools., Results: In this 6-month prospective study, 67 CKD patients were enrolled: 77% with stage 3 or 4 CKD (by Kidney Disease Improving Global Outcomes criteria), 66% males, 76% with diabetes, median age 70 years (range 59-75), with a mean 2.6 ± 1.2 comorbidities and 10 ± 3.5 medications. We registered 142 DRPs, in 93% of patients, which mainly concerned untreated indications (31.7%) and incorrect dosages (19%). The most frequent pharmaceutical interventions concerned addition of drug (34%) and adaptation of dose (25.5%). The main drugs involved concerned the cardiovascular (33%), digestive-metabolic (26.9%) and hematopoietic (19.9%) systems. DRPs correlated significantly with a higher number of medications (p=0.049) and with older patient age (p=0.0027). Furthermore, patients' knowledge was evaluated in 41 patients (61%) by the CP with a systematic questionnaire. Three at-risk situations were described: 80.5% of patients interviewed were unaware of the beneficial impact of their treatment, 85% were not aware of medical situations at risk and 68% declared self-medication habits., Conclusion: A formatted CP evaluation coupled with a renal consultation was able to detect a higher level of DRPs, to reinforce educational messages and to propose immediate changes in the therapeutic project.

Objectives: To assess the impact of continuous incident reporting and subsequent prevention strategies on the incidence of severe iatrogenic events and targeted priorities in admitted neonates., Methods: We performed preintervention (January 1 to September 1, 2005) and postintervention (January 1, 2008, to January 1, 2009) prospective investigations based on continuous incident reporting. Patient-safety initiatives were implemented for a period of 2 years. The main outcome was a reduction in the incidence of severe iatrogenic events. Secondary outcomes were improvements in 5 targeted priorities: catheter-related infections; invasive procedures; unplanned extubations; 10-fold drug infusion-rate errors; and severe cutaneous injuries., Results: The first and second study periods included totals of 388 and 645 patients (median gestational ages: 34 and 35 weeks, respectively; P = .015). In the second period the incidence of severe iatrogenic events was significantly reduced from 7.6 to 4.8 per 1000 patient-days (P = .005). Infections related to central catheters decreased significantly from 13.9 to 8.2 per 1000 catheter-days (P < .0001), as did exposure to central catheters, which decreased from 359 to 239 days per 1000 patient-days (P < .0001). Tenfold drug-dosing errors were reduced significantly (P = .022). However, the number of unplanned extubations increased significantly from 5.6 to 15.5 per 1000 ventilation-days (P = .03)., Conclusions: Prospective, continuous incident reporting followed by the implementation of prevention strategies are complementary procedures that constitute an effective system to improve the quality of care and patient safety.

Objective: To determine the incidence, risk factors, severity, and preventability of iatrogenic events (IEs) as a cause of intensive care unit (ICU) admission., Design: Comparison of patients admitted or not for IE. IE was diagnosed after assessing independently predefined criteria., Setting: The ICU of a teaching hospital., Patients: All patients consecutively admitted over 6 months., Interventions: None., Measurements and Results: Characteristics of patients, supportive treatments, length of stay, and outcomes were recorded. For patients admitted for IE, cause, origin, and preventability of IE were assessed by consensus. Of 528 patients, 103 (19.5%) were admitted for IE. Their Simplified Acute Physiology Score (SAPS) II was higher (41.2 +/- 22.6 versus 31.4 +/- 18.6), as was their Logistic Organ Dysfunction (LOD) score. Surgical admissions and admission for shock were more frequent. The main risk factors were age, underlying disease, low Mac Cabe or Knaus score, number of physicians treating the patient, number of drugs prescribed, and other hospitalization within 1 month. Length of stay was higher (11.1 days versus 7.9 days, 0.5-6.0, p = 0.02). Catecholamine drugs, blood transfusion, and parenteral nutrition were more frequently required in the IE group. ICU mortality was 15.5% in the IE group and 11.3% in the group without IEs [not significant (ns) after adjustment]. IE was considered as probably preventable in 73.8% of cases., Conclusion: Of admissions to the ICU, 19.5% resulted from IE, with high proportion of shock, leading to greater need for invasive treatments and longer stay in the ICU. Most cases of IE seemed preventable.

Iatrogenic pathology is currently a serious problem. Intensive care units (ICU) are wards with a high risk of occurrence of adverse events (AE) related to the care and medical errors. The incidence of AE in ICU varies from 3 to 31% according to the publications. These variations are mainly due to the methodology of data collection. The latter is essential. The indicators must be standardized (consensual definitions), and easily collected. The method of collection must be ideally prospective, nonpunitive, confidential, independent within a compliant team, and realized with the participation of various actors not only of the unit but also external (biologists, pharmacists). The risk factors of AE in ICU are known: old age and high severity scores at admission, with medical and nurse workload more important. AE are associated with an increased patients' morbidity in ICU with no evident causality. The over cost related to AE in ICU was quantified to 3961 dollars in the United States. The mortality of patients with an AE is higher but no study showed to date that AE constituted an independent risk factor of mortality in ICU. Some AE are preventable (from 28 to 84% according to studies). Therefore, the implementation of procedures of security (PS) is capital. Many methods often easy to implement exist such as in care, structural and managerial procedures. The development of a safety culture in hospitals and other delivery care settings is essential. It is the first essential step in a better comprehension of the health care professionals and the public opinion.

Background: Iatrogenic events are increasingly recognised as an important problem in all people admitted to hospital. However, few epidemiological data are available for iatrogenic events in neonatal high-risk units. We aimed to assess the incidence, nature, preventability, and severity of iatrogenic events in a neonatal centre and to establish the association of patient characteristics with the occurrence of iatrogenic events in neonates., Methods: We undertook an observational, prospective study from Jan 1, 2005, to Sept 1, 2005, including all neonates admitted in the Division of Neonatology of an academic, tertiary neonatal centre in southern France. Iatrogenic events were defined as any event that compromised the safety margin for the patient, in the presence or absence of harm. The report of an iatrogenic event was voluntary, anonymous, and non-punitive. The primary outcome was the rate of iatrogenic events per 1000 patient days., Findings: A total of 388 patients were studied during 10 436 patient days. We recorded 267 iatrogenic events in 116 patients. The incidence of iatrogenic events was 25.6 per 1000 patient days. 92 (34%) were preventable and 78 (29%) were severe. Two iatrogenic events (1%) were fatal, but neither was preventable. The most severe iatrogenic events were nosocomial infections (49/62 [79%]) and respiratory events (nine of 26 [35%]). Cutaneous injuries were frequent (n=94) but generally minor (89 [95%]), as were medication errors (15/19 [76%]). Most medication errors occurred during administration stage (12/19 [63%]) and were ten-fold errors (nine of 19 [47%]). The major risk factors were low birthweight and gestational age (both p<0.0001), length of stay (p<0.0001), a central venous line (p<0.0001), mechanical ventilation (p=0.0021), and support with continuous positive airwary pressure (p=0.0076)., Interpretation: Iatrogenic events occur frequently and are often serious in neonates, especially in infants of low birthweight. Improved knowledge of the incidence and characteristics of iatrogenic events, and continuous monitoring could help to improve quality of health care for this vulnerable population.

Introduction: The misuse of drugs, common practice for some, is a source of iatrogenic diseases and considerable supplementary costs in hospital budgets. The aim of this study was to quantify the number of adverse events (AE) related to the misuse of drugs., Methods: This was a study conducted on 200 new validated AE case reports. In each report, we searched for the drug(s) responsible and checked whether the prescription respected the SPC (summary of product characteristics) and current guidelines or not., Results: Among the 200 reports, 49 (24.5%) cases of AE were related to the misuse of a drug in 46 patients, with a mean age of 65.8 years [24 to 97]. Among these cases, 33 (67.3%) were at the origin of hospitalisation or prolongation of the latter. In 17 cases (34.7%), there was no therapeutic alternative to the drug used in the framework of misuse., Discussion: The notion of good or bad use of a drug progresses with the life of the drug. We therefore selected as criterion of misuse the non-respect of the SCP but also other guidelines. Regarding the cases that could have been avoided, these concerned an AE related to poor surveillance and assessment of the benefit/risk ratio of treatments prescribed to elderly patients and also the commonplace use of non-steroidal anti-inflammatories, at the origin of digestive haemorrhages., Conclusion: The prevention of misuse implies all the actors of the health system. A reassessment of the prescription of certain therapeutic classes of drugs would avoid a great number of iatrogenic accidents and would lead to considerable economy in the field of health.

In addition to being a fast-growing subpopulation, the elderly also receive large quantities of medication and are particularly exposed to iatrogenic effects. In France, 8.6 per cent of hospitalizations of patients over the age of 70 are due to an adverse event. This workshop comprising pharmaceutical companies, pharmacologists, geriatricians and health authorities aimed to make propositions for improving drug research in the elderly in order to prevent iatrogenic drug reactions by encouraging more rigorous application of existing guidelines. In addition to information extrapolated from clinical trials conducted on young or healthy people, it is imperative to include in clinical trials a sufficient number of elderly patients and to take into consideration specific criteria such as multiple medication regimens, concomitant diseases, cognitive impairment and motor disturbances. The assessment of drugs used in the elderly must be based on a specific and validated geriatrics scale and in some cases (postmarketing studies) may be based on specific trials (those called 'conducted in the real world').

The prevention of preventable adverse therapeutic events (iatrogenic), especially drug related, is a major medical goal for patients, economics and the community. Its incidence is 5 to 15 per cent of hospitalization days. Preventable iatrogenic is a main problem in terms of public health owing to its human and economic consequences. Prevention of iatrogenic is based on better knowledge of its reality, on well-adapted initial and long-term intensive training of physicians, other healthcare workers and also patients and citizens. A better healthcare system is also needed.

As a group, non-steroidal anti-inflammatory drugs (NSAIDs) rank first among commonly prescribed drugs for serious adverse reactions. We conducted a cross-sectional survey in which 1072 French general practitioners (GPs) were evaluated for their basic pharmacological knowledge and practice of NSAIDs prescription. Results suggest that GPs have insufficient pharmacological knowledge and provide inadequate management of adverse reaction risk. Well-established risk factors for serious adverse reactions, such as age, are not taken enough into account, and tolerance is not correctly monitored. Drugs allegedly protecting against peptic ulcers are frequently associated but, most of the time, without any relevant justification, such as the patient's risk level or drug's efficacy. Our findings demonstrate a need for greater information among GPs about prescription and tolerance monitoring of NSAIDs.

One hundred and fifteen cases of iatrogenic disorders were observed in 106 patients during a one-year prospective study. Each case was included after informed agreement of two investigators. Each case was classified into 4 groups, according to duration time between iatrogenic disorder and hospitalization, and into 3 sections according to responsibility of causative agent. A control group of 200 patients matched for age and sex was studied. Patients represented 8% of the hospitalisations. Mean age (69.2 years) was higher than other patients hospitalized during the same period (61.6 years). Principal causative agents were diuretics (30), physchotrops (13) and technic examinations (12). Main pathologies were electrolytes disorders (28), orthostatic hypotension (19), confusion and/or alteration of mental functions (13), and cutaneous or allergic disorders (12). Mean induced hospitalization duration time was of 8 days. Mean estimate cost was 18,808 francs per patient. Associated factors were elderly, and an elevated number of drugs. A negligency could participate to iatrogenic disorders in 50% of cases. Half part of iatrogenic disorders could be avoided by using simple precautions: respect of contra-indications, restriction on self-therapy and of number of associated drugs.

In 100 records collected from a neonatal intensive care unit, 19 cases of insufficient prevention were noted. In some of them, several tactical faults affected the same infant. In 9 cases pre- or perinatal surveillance was lacking; there were 9 cases of inappropriate transfer and 11 cases of iatrogenic complications. Three mothers refused all examinations. In all other cases, both medical and paramedical staffs did not utilize the means at their disposal to satisfaction. We conclude that for a better effective use of intensive care it seems rational to convince the perinatology actors to exploit under good conditions the existing possibilities of prevention rather than demanding a reinforcement of the present statutory structures.

A study was made of iatrogenic complications (IC) occurring in the department of cardiology of the Nantes Teaching Hospital Group between May 31, 1990 and June 1, 1991. One hundred and fifty eight IC were seen during this period, i.e. an annual incidence of 4.4%. There were 4 deaths following and IC, i.e. an annual mortality rate of 0.11%. Five other IC had serious though non-fatal consequences. Taken in general, IC appeared to be benign and of various origins. Drugs were responsible for almost half of IC and invasive investigations for one third. Application of a simple and single preventive approach is difficult in view of the diversity of causes. The solution lies in part in awareness and education concerning the problem, in which a permanent register system like ours certainly has a role to play.

Our one-year retrospective study evaluated drug use in a population of 136 patients over 60 years old hospitalized in a geriatric ward (moderate--and long-term institutionalization). After having classified the reason for hospitalization, the length of stay and the number of pathologies per patient, the number of prescribed medications was quantified by means of a drug-day unit (D-D). The mean number was 3.36 D-D, which was independent of sex, age and reason for admission. The most frequently prescribed medications treated central nervous system, cardiovascular and metabolic disorders. These results were compared to those of CREDOC 1981 and CREDES 1987. In addition, 14 iatrogenic episodes were identified in this study; aminoglycosides and cardiovascular drugs were responsible for the majority of them, despite the precautions taken in light of the therapeutic indications. The iatrogenesis thus identified was not due to biological abnormalities found in the elderly. In our opinion, this evaluation of drug use is a good predictive element for understanding iatrogenicity on a larger scale and thereby to attempt to avoid it.

The authors looked at the clinical situation and the possible pathogenicity which in this case was almost certainly traumatic. It would explain the total absence of one leg at the delivery of a baby who had no other psychomotor changes. They used this very exceptional case history of the loss of the lower limb after an attempt at terminating a pregnancy to study the matter from the French and foreign bibliography on the subject, which anyhow is very short. There was an attempt to terminate a pregnancy at an undisclosed duration of amenorrhoea (between 9 and 13 weeks) by suction evacuation followed by curettage. On the medico-legal side the authors analysed the reasons why there was no penal indictment brought at the same time as the civil action was brought prosecution, and also points out that the Conseil d'Etat decided, contrary to the Administrative Tribunal who were petitioned as to the responsibility for the serious handicap this child suffered to be established publically. They analysed the evolution of judicial and administrative jurisprudence on the matter of failure to terminate a pregnancy. The authors list other possibilities for traumatising a fetus in utero when the inside of the uterus is explored either when the pregnancy is a spontaneous pregnancy or an assisted reproductive pregnancy. The cases of pregnancy requiring a reduction in the number of embryos who will be born or the destruction of handicapped children whose legal status seems not only to be recognised at birth, but even in utero by the judges of the supreme administrative court.