Search

Background and importance Following the computerisation of prescriptions in the plastic surgery department of our hospital, some protocols have been modified, leading to an increase in iron supplementation (IS) prescriptions by anaesthetists in postoperative care. Aim and objectives The aim of our study was to perform an inventory of iron prescriptions and administrations in order to assess their relevance Material and methods A retrospective analysis was performed from 29 January 2019 to 29 August 2019. Compliance of IS administrations with preoperative prescriptions and biological examinations was assessed. The local protocol recommended first intention use of iron saccharose hydroxide (ISH) when possible (due to the cost of ferric carboxymaltose (FCM)) and also defined the relevant biological parameters to achieve these administrations (1 g of FCM or two injections of 300 mg ISH separated by a 48 hour interval if haemoglobin Results Sixty-nine IS prescriptions were collected, of which 32 (46%) were followed by an administration. The average length of stay (ALS) for patients was 2.8 days. Of these 69 prescriptions, 27 (39%) were not associated with the prescription of an iron biology (IB). Twenty-two administrations of ISH, 7 of FCM, 1 of ferrous fumarate and 2 of ferrous sulphate, were performed. Of these 32 administrations, 21 (66%) were justified by the IB. For the 11 others, the IB was incomplete. Of the 22 patients who received ISH, 18 (82%) received only one postoperative dose. Conclusion and relevance In agreement with the protocol, ISH was mainly prescribed. Nevertheless, the ALS of the patients was incompatible with the administration recommendation. We note that in each case where an IB was complete, an IS was justified in postoperative care. This work will be followed by a consultation with the anaesthetists. Reflection on the dose and galenic of IS in relation to the iron deficiency calculation for each patient would be interesting in the context of a possible improved recovery programme after surgery. References and/or acknowledgements No conflict of interest.

Background and importance Since 2015, a pharmacist/resident duo has been conducting drug reconciliation and medication review in the orthopaedic surgery department. They participate in multidisciplinary team (MDT) meetings to discuss patient with osteomyelitis. These clinical case conferences take place every week to determine the most suitable surgical and medical treatments for individual patients. Aim and objectives The objective of this study was to assess the impact of the pharmacist’s involvement in the MDT meetings on the medical management of patients with osteomyelitis. Material and methods A prospective study was conducted on all pharmaceutical recommendations (PRs) made during the MDT meetings. The data collection period was from June to September 2019. All patients had their medications reconciled previously. We used the drug related problem classification system (DRP)1 to rate the PRs and to identify the problems, causes, types and outcomes of these interventions. Results Of the 17 MDT meetings, 220 patient records were reviewed and 24 PRs were identified. The pharmacist provided information about the patient, along with treatment and recommendations in 38% of cases (renal function, galenic alternatives, previous prescriptions, availability and cost of the drug). For 62% of patients, this information changed the therapeutic decision: choice of antibiotic (33%), potential interactions with long term medications (29%), need to add a drug (12.5%) and optimal dosing for 8% of cases (subtherapeutic in 4%, overdosing in 4%). A large majority (95.8%) of the recommendations were accepted by the prescribers. The most common class of medication was systemic antibiotics (88%). Conclusion and relevance The work of medication reconciliation and checking prescriptions was carried out by the pharmacist in the orthopaedic department and this allowed better understanding of the patient and their medication. By participating in MDT meetings, the pharmacist can communicate directly with the prescriber and contribute to clinical decision making regarding anti-infective medications. The clinical pharmacist provided a comprehensive review and therefore played a major role in the medical management of patients with osteomyelitis. References and/or acknowledgements https://www.pcne.org/upload/files/334_PCNE_classification_V9-0.pdf No conflict of interest.

Background In 2015, our center replaced vancomycin with linezolid for the postoperative empirical treatment of osteoarticular infections (OAI). Objectives To assess the bacteriological relevance of linezolid for orthopedic postoperative probabilistic antibiotic therapy. Methods Analysis of an observational cohort of patients empirically treated with a combination of linezolid and piperacillin/tazobactam during the immediate postoperative stage for an OAI between July 1st 2015 and July 1st 2016, in a French reference center. Results Seventy-seven of 126 patients who received a probabilistic postoperative combination of linezolid with piperacillin/tazobactam had microbiological proof of infection. Sixty-six of 77 OAI involved material, including an osteosynthesis in 45 cases (68%) and prosthesis in 21 cases (32%). Infection was due to Gram-positive bacteria in 62 cases (80.5%), mostly S. aureus (n=32, 41.6%), and S. epidermidis (n=14, 18.2%) accounting for 74.2% of Gram-positive bacteria. Among 14 OAI due to S. epidermidis, 11 (78.6%) were due to methicillin-resistant strains. All the S. aureus and S. epidermidis strains were susceptible to linezolid (MICs ≤ 4 mg/L), except in one patient previously treated with linezolid who was infected with a linezolid-resistant S. epidermidis strain (MIC > 256 mg/L). Conclusion Linezolid can be used empirically in postoperative antibiotic therapy of OAI before obtaining definitive microbial results. Although linezolid resistance is rare in this population, previous oxazolidinone treatment should be documented before initiation of probabilistic postoperative treatment to highlight potential linezolid resistance.

Background Medication errors frequently occur in surgical units, partly due to the large number of prescribers (surgeons, anaesthetists, dieticians) and to potential interactions between anaesthesia and medications taken by the patient. In order to reduce these errors in digestive and urological surgery, a mobile team of clinical pharmacists has been deployed. The activities (medication reconciliation (MR), pharmaceutical analysis and optimisation at the patient’s bedside) are led by a pharmacist, a pharmacy resident and two students. Purpose The objective of our study was to evaluate the impact of a clinical pharmacy organisation on patient care safety and the satisfaction of physicians and nurses in digestive and urological surgical units (84 beds). Material and methods Over 9 months, all pharmaceutical interventions (PI) were registered and categorised according to the French Society of Clinical Pharmacy (SFPC). The number of PIs leading to a prescription’s modification was recorded. A satisfaction survey was performed 8 months after the deployment: 104 professionals (surgeons, residents, anaesthesiologists, nurses) were interviewed to evaluate their satisfaction. The survey included questions regarding the quality of information provided by the pharmaceutical team and the impact on patient safety. Results Since November 2016, 2808 patients benefited from the pharmaceutical team, and 1,334 PIs have been performed. Those PIs concerned 23.5% of the patients: most of them were related to inadvertently omitted medications (38%) or incorrect posology (32%). 1159 (87%) PIs were accepted by the prescriber and led to a prescription modification. Regarding the satisfaction survey, we collected 58 answers: 96% of the respondents were satisfied by the actions of the team and 98% agreed that those activities increased patient care safety. Furthermore, 94% thought that other surgery units should benefit from the same activities. Conclusion The high acceptance rate of PIs demonstrates the importance of the pharmaceutical team in improving healthcare safety regarding medications. The satisfaction survey confirms that the pharmaceutical offer is well accepted and useful to healthcare professionals. Finally, since the deployment of the team, we observed a simultaneous decrease in medications expenses in the units (−17%), allowing continuity of the actions taken and extension of the team in other surgical units. No conflict of interest

Pour repondre aux problematiques de securisation de la prise en charge medicamenteuse, nous avons mis en place une prestation de pharmacie clinique globale et integree au sein d’unites de chirurgie. Une equipe composee d’un pharmacien assistant, d’un interne, de 2 etudiants de 5e annee et d’un preparateur. Outre la conciliation, l’equipe assure l’optimisation des prescriptions et la securisation du circuit du medicament dans les 3 unites de chirurgie orthopedique (84 lits). Nous realisons en moyenne 300 conciliations par mois. L’objectif de cette enquete est d’evaluer la satisfaction des professionnels medicaux et paramedicaux beneficiaires de cette prestation. L’enquete a ete realisee a 6 mois du deploiement de l’equipe pharmaceutique sur une periode de 15 jours Les 71 personnels des 3 unites d’hospitalisation ont ete consultes (30 infirmiers, 3 cadres de sante, 1 geriatre, 12 anesthesistes, 10 internes de chirurgie et 15 chirurgiens). Le questionnaire etait sous forme papier pour le personnel infirmier et sous forme informatisee pour les autres. La version dematerialisee a ete realisee avec le logiciel institutionnel (Sphinx®) et a ete diffusee par courriel. Apres saisie des questionnaires papiers dans Sphinx®, le logiciel a traite les donnees. Le questionnaire est compose de 12 items. Les themes abordes sont la qualite des informations apportees par l’equipe, la securisation du circuit, le gain de temps pour les utilisateurs. Au total, 47 professionnels de sante ont repondu a l’enquete de satisfaction dont 67 % de medecins. La quasi-totalite des repondants (95 %) ont un avis favorable a la mise en place d’une equipe de pharmacie clinique dans une unite de chirurgie. La grande majorite des interroges (94 %) sont satisfaits des prestations de l’equipe de pharmacie clinique et ne reviendraient pas a l’ancienne organisation. La mise en place d’un support unique de prescription integrant le bilan medicamenteux optimise satisfait 96 % des sondes. Le personnel medical et paramedical affirme a 87 % que le travail de l’equipe de pharmacie leur fait gagner du temps. La prestation de pharmacie clinique serait benefique pour une autre unite de chirurgie selon 94 % des repondants. La methodologie de diffusion des questionnaires nous a permis d’avoir un fort taux de reponse du corps medical et paramedical. Les resultats de l’enquete sont tres satisfaisants et montrent l’interet des equipes pour ce projet. L’offre globale de pharmacie clinique est donc tres bien acceptee de la part de tous les professionnels de sante. Ces resultats sont un support pour le developpement de l’activite de pharmacie clinique dans d’autres unites de chirurgie.

Objectifs En 2009, l’enquete ENEIS montrait une survenue d’evenements indesirables graves pendant l’hospitalisation majoritairement dans les services de chirurgie. Dans ce contexte, une equipe de pharmacie clinique (EPC) est deployee depuis 2015 dans notre centre hospitalier. Constituee de pharmaciens et d’internes, elle a pour missions l’analyse pharmaceutique des prescriptions, l’optimisation therapeutique et permet d’assurer la continuite des traitements entre la ville et l’hopital. L’objectif est d’analyser l’impact de l’EPC dans les services d’urologie sur la prise en charge des patients. Methodes L’etude s’etend de novembre 2016 a avril 2017 dans 3 unites de chirurgie dont une unite urologique (soit 84 lits). L’EPC est inscrite dans le parcours de prescription. Pour tous les patients hospitalises dans le service d’urologie, programmes ou non, elle recoupe au moins 3 sources pour rediger la liste exhaustive des traitements habituellement pris. Cette liste est confortee par un entretien avec le patient quand cela est possible et aboutit a une proposition de prescription a valider par le medecin (interne ou senior d’urologie). La comparaison de la consultation d’anesthesie ou de la premiere prescription hospitaliere avec cette liste permet d’identifier des divergences et des interactions avec le traitement habituel du patient et donne lieu a une intervention pharmaceutique. Resultats Sur la periode etudiee, l’EPC a concilie et fait des propositions de prescription pour 1971 patients (67 % de patients programmes, 33 % de patients urgents). Au total, 474 patients ont beneficie d’au moins une intervention pharmaceutique, soit environ un patient sur quatre. Les principales divergences identifiees sont des oublis de traitements (46 %) et des posologies erronees (24 %). Les medicaments les plus representes sont ceux du systeme cardiovasculaire (23 %) et ceux du systeme nerveux (21 %) selon la classification Anatomique, Therapeutique et Chimique. Conclusion La presence quotidienne de l’equipe mobile de pharmacie clinique apporte, en plus d’une optimisation du temps medical dans les unites d’hospitalisation d’urologie, une reelle securisation de la prescription medicamenteuse indispensable a la prise en charge de patients de plus en plus polypathologiques.