[SARS-COV-2 pandemic: Involvement of the hospital pharmacist in securing patient care]. / Pandémie à SARS-COV-2 : implication du pharmacien hospitalier dans la sécurisation de la prise en charge des patients.

OBJECTIVES: In the context of the SARS-CoV-2 pandemic, hospital pharmacists supported the implementation of recommendations and ensured the safety of patient medication management. The aim of this study is to establish the interest of the involvement of the hospital pharmacist in this context by describing and comparing the activities carried out with patients with COVID-19 and those without. METHODS: During the study period, data on clinical pharmacy activities with hospitalized patients were collected and analyzed: pharmaceutical analysis of prescriptions, participation in multi-professional consultation meetings (RCP) dedicated to COVID-19, and monitoring of adverse events. RESULTS: The activities concerned 1483 patients, including 444 with COVID-19, resulting in 575 pharmaceutical interventions (PI). The main problems identified were overdoses, untreated indications, and drug-drug interactions (DDI). AMIs were significantly more common in patients with COVID-19, with 73.3% involving disease-specific therapies. Eleven PIs had a life-threatening impact, 189 a major impact. During the PCRs, 36 PIs were performed for 59% of the patients presented. A pharmacovigilance report was performed for a quarter of patients treated with hydroxychloroquine and 33% of patients treated with lopinavir/ritonavir. CONCLUSIONS: This study demonstrates the value of involving hospital pharmacists in the drug management of patients with COVID-19, particularly with the evolution of available therapies and the implementation of vaccination, in order to reduce the spread of SARS-COV2 and limit the appearance of resistance.

Impact of the COVID-19 Pandemic on Antihyperglycemic Prescriptions for Adults With Type 2 Diabetes in Canada: A Cross-sectional Study.

OBJECTIVES: Diabetes is a major public health problem in Canada and requires multifactorial, consistent clinical management. The COVID-19 pandemic has increased challenges in the management of many chronic ailments, including diabetes. Diabetes was associated with a higher risk of severe illness in the context of COVID-19. Pandemic restrictions also impacted diabetes care continuity, which may have contributed to an increased risk of diabetes-related complications and mortality. METHODS: This was a retrospective cross-sectional study of prescription patterns of antihyperglycemic medications claimed by individuals with type 2 diabetes (T2D) before and during the COVID-19 pandemic using the IQVIA Canada Longitudinal Prescription Claims database. The study period was from March 1, 2018, to February 28, 2021. The study outcomes are described on a monthly, quarterly, and yearly basis and overall, and by medication, medication class, and insurance coverage type. "New-to-molecule" patients were defined as those claiming a medication during the analysis period that they had no history of claiming in the database. Adults with at least 1 year of prescription history available and claiming their first prescription for an antihyperglycemic drug during the analysis period were classified as newly diagnosed with T2D. RESULTS: A similar number of people had at least 1 non-insulin antihyperglycemic prescription during the baseline, prepandemic, and pandemic periods in Canada (1,778,155, 1,822,403, and 1,797,272, respectively). However, the number of people initiating newer antihyperglycemic medications decreased at the beginning of the pandemic, in contrast to older medications, which remained consistent across the pandemic period. The number of people diagnosed with T2D decreased in the early months of the pandemic but recovered by October 2020. CONCLUSION: The COVID-19 epidemic in Canada impacted clinical care for at-risk Canadians, with fewer being prescribed newer antihyperglycemic drugs and a reduction in the number of diagnoses of T2D.

[Medication reconciliation on admission: One year of practice in health care institutions during the COVID-19 pandemic]. / Conciliation médicamenteuse à l'admission : bilan d'une année d'activité en établissement de santé durant la crise COVID-19.

OBJECTIVES: Medication reconciliation is a key point of the v2020 certification. The main objective of this study was to evaluate this activity over one year, including the first epidemic wave at COVID-19. The secondary objectives were to identify the obstacles and levers and to evaluate doctor satisfaction. METHODS: This was a retrospective study of drug reconciliations performed on admission during 12 months of the emergence of COVID-19. Patients aged 65 years and older from orthopedic and visceral surgery, acute hospitalization and conventional medicine units were included. Unintentional discrepancies were analyzed. The obstacles and levers were identified by means of a focus group. Doctors' satisfaction was collected using online quiz. RESULTS: A total of 760 patients were conciliated, of which 27% (n=208) by hospital pharmacy technicians. A decrease in activity was observed during the first epidemic wave. An unintentional discrepancy was found in 77% of patients, and only 48% were corrected by the prescriber. These results were impacted by the pandemic. The pharmaceutical team was mobilized in the logistical management of the crisis, but it was able to adapt in order to perpetuate the activity. Doctors are satisfied with the process. CONCLUSIONS: Medication reconciliation on admission is essential for the prevention of iatrogeny, particularly with the impact of the COVID-19 pandemic in healthcare institutions.

Campagne de vaccination contre la Covid-19: Retour d’expérience de l’équipe pharmaceutique d’un établissement pivot

Résumé La mise à disposition du 1 er vaccin contre la Covid-19 en décembre 2020 a entrainé une réorganisation importante des activités des pharmacies à usage intérieur des établissements pivots, afin de permettre le déploiement rapide de la vaccination sur l’ensemble du territoire. Cette campagne vaccinale, transversale et pluri professionnelle, est caractérisée par de multiples facteurs de complexité. La sécurisation du circuit de ces nouveaux vaccins a été l’un des points cruciaux, tant au niveau des conditions de conservation particulières qu’au niveau du respect des bonnes pratiques de préparation et d’administration. La diversité des acteurs impliqués, de la nature des centres pratiquant cette vaccination, l’urgence de la situation ainsi que la quantité de vaccins dispensés ont montré l’intérêt de l’accompagnement réalisé par les équipes pharmaceutiques afin de limiter le risque d’erreurs médicamenteuses. De nouvelles missions du pharmacien et de nouveaux défis ont émergé de cette campagne vaccinale dans ce contexte exceptionnel. Nous souhaitons ici faire le retour d’expérience de l’équipe pharmaceutique d’un établissement pivot. The availability of the first Covid-19 vaccine in December 2020 has led to a major reorganization of the pharmaceutical's activities in order to allow the rapid deployment of the vaccination throughout the country. This cross-functional and multi-professional vaccination campaign is characterized by many factors of complexity. Securing the circulation of these new vaccines was one of the crucial points, both in terms of specific storage conditions and compliance with good preparation and administration practices. The diversity of the actors involved, the nature of the centers practicing this vaccination, the emergency of the situation and the important quantity of vaccines dispensed have demonstrated the value of the support provided by the pharmaceutical team in order to limit the risk of errors. New tasks for the pharmacist and new challenges have emerged from this exceptional vaccination campaign. We would like to provide a feedback here.

Consultations en télésoin pharmaceutique avec dispensation médicamenteuse dématéralisée en contexte sanitaire exceptionnel : preuve de concept et perspectives

Résumé Lors du contexte de crise sanitaire exceptionnelle provoquée par la pandémie de COVID-19, un programme de consultations en télésoin pharmaceutique, associées à des dispensations dématérialisées de traitements avec envoi à domicile ou drive, a été mis en place par le service de la pharmacie de notre établissement. Le dispositif a concerné 25 % des dispensations ambulatoires de la PUI sur la période du premier confinement et a permis à 351 patients de ne pas se rendre à la pharmacie de l’hôpital, tout en conservant une prestation pharmaceutique de qualité. Si certaines limites ont été relevées, comme l’accès à la technologie ou l’augmentation du temps pharmaceutique dédié, ce dispositif, apprécié des patients et des médecins, a permis de maintenir, voire de renouer, un lien pharmaceutique privilégié avec de nombreux patients. Summary During the exceptional health crisis caused by the COVID-19 pandemic, a program of telepharmacy consultations, associated with dematerialized dispensing of treatments with delivery to the home or drive, was set up by the pharmacy department of our institution. The system has concerned 25 % of the ambulatory dispensations of the PUI over the period of the first containment, and allowed 351 patients to avoid coming to the hospital pharmacy, while maintaining a quality pharmaceutical service. Although certain limitations were identified, such as access to technology or the increase in dedicated pharmaceutical time, this system, appreciated by patients and physicians, has enabled a privileged relationship to be maintained with many patients. Expert clinical pharmacists now also perform PT, and treatments are now sent to patient's pharmacies.

Barriers and Facilitators Related to Delivery of Hospital Pharmacy Services to Women, Children, and Their Families during a Pandemic: A Qualitative Study.

Background: When the COVID-19 pandemic was declared in March 2020, health care professionals were challenged to adapt quickly and efficiently to change their work practices. However, an evidence-informed approach has not yet been used to systematically gather data on barriers and facilitators related to delivery of hospital pharmacy services in Canada. Objectives: The primary objective was to identify and describe barriers and facilitators related to the delivery of hospital pharmacy services to women, children, and their families during the COVID-19 pandemic. The secondary objective was to provide recommendations for improvement in delivery of pharmacy services to enhance patient care during pandemics. Methods: This qualitative study involved semistructured virtual interviews with pharmacists who worked in direct or nondirect patient care throughout the pandemic (since March 2020) at women's and/or children's hospitals in Canada. Individual interviews were completed virtually using conferencing software. An interview guide mapped to the Theoretical Domains Framework version 2 (TDFV2) was used to facilitate the interviews. Interviews were audio-recorded and transcribed verbatim by the principal investigator. Transcribed interviews were coded, mapped to the TDFV2, and analyzed using thematic analysis. Results: Interviews were completed with 21 pharmacists in 7 provinces across Canada. Barriers and facilitators coded to the TDFV2 were grouped into 4 main themes: communication and collaboration, adaptability, health and well-being, and preparedness. Conclusions: Participants highlighted a significant number of barriers that they experienced during the COVID-19 pandemic; overall, however, participants reported that they felt prepared for subsequent waves of the COVID-19 pandemic and future pandemics.

Contexte: Lors de la déclaration de la pandémie de COVID-19 en mars 2020, les professionnels de la santé ont été mis au défi de s'adapter rapidement et efficacement à la situation en changeant leurs pratiques professionnelles. Cependant, une approche fondée sur des données probantes pour recueillir systématiquement des données sur les obstacles à la prestation des services de pharmacie hospitalière au Canada et les éléments facilitant celle-ci n'a pas encore été utilisée de manière systématique. Objectifs: L'objectif principal consistait à identifier et à décrire les obstacles à la prestation de services de pharmacie hospitalière aux femmes, aux enfants et à leur famille et les éléments facilitant celle-ci pendant la pandémie de COVID-19. L'objectif secondaire consistait, quant à lui, à fournir des recommandations pour améliorer la prestation de services de pharmacie afin d'améliorer les soins aux patients pendant une pandémie. Méthodes: Cette étude qualitative comprenait des entrevues virtuelles semi-structurées avec des pharmaciens ayant travaillé dans le domaine des soins directs ou non directs aux patients tout au long de la pandémie (depuis mars 2020) dans des hôpitaux pour femmes et/ou enfants au Canada. Les entretiens individuels ont été réalisés virtuellement à l'aide d'un logiciel de conférence. Un guide d'entretien adapté de la 2e version du cadre des domaines théoriques (TDFV2) [Theoretical Domains Framework] a été utilisé pour faciliter les entretiens. Ceux-ci ont été enregistrés sur bande audio et retranscrits textuellement par le chercheur principal. Les entretiens ainsi retranscrits ont été codés, reportés sur le TDFV2 et analysés par thème. Résultats: Des entrevues ont été réalisées auprès de 21 pharmaciens dans 7 provinces du Canada. Les obstacles et les éléments facilitateurs codés selon le TDFV2 ont été regroupés en 4 grands thèmes: communication et collaboration; adaptabilité; santé et bien-être; et état de préparation. Conclusions: Les participants ont mentionné un nombre important d'obstacles qu'ils ont rencontrés pendant la pandémie de COVID-19; dans l'ensemble, cependant, les participants ont déclaré qu'ils se sentaient préparés aux vagues ultérieures de la pandémie de COVID-19 et aux futures pandémies.

Plan d’urgence sanitaire appliqué à une pharmacie hospitalière durant la pandémie COVID-19 : le retour d’expérience de l’Institut national d’oncologie marocain

Résumé Objectifs Une pandémie est une catastrophe sanitaire pouvant conduire à la perturbation du déroulement des activités de soins au sein d’un établissement hospitalier. L’objectif de ce travail est la présentation d’un modèle de plan d’urgence sanitaire applicable à la pharmacie hospitalière en temps de crise, et la description de l’expérience de la pharmacie de l’Institut national d’oncologie marocain dans la lutte contre la pandémie COVID-19. Méthode Mise en place d’un ensemble de procédures pour l’organisation pharmaceutique dans le cadre d’un plan d’urgence sanitaire, la création d’un dispositif dont la dotation permet la prise en charge rapide de 25 patients simultanés, et d’un système de gestion des risques de pénuries. Par ailleurs, l’ensemble des missions assurées par la pharmacie durant la pandémie COVID-19 ont été présentées et commentées. Résultats Élaboration de trois listes de produits de santé indispensables à l’exercice de médecine de catastrophe, d’un total de 125 références. Les modalités de leur engagement et de réapprovisionnement sont définies par une procédure de déploiement de la pharmacie du plan d’urgence sanitaire. Conclusion En temps de crise, les systèmes d’approvisionnements habituels sont fortement perturbés et les ruptures en produits de santé sont nombreuses. Dans ce sens, un plan d’urgence préétabli prévoit une organisation pluridisciplinaire où la pharmacie hospitalière joue un rôle déterminant. Summary Objectives A pandemic is a health disaster that can lead to the disruption of hospital's health care activities. The objective of this work is the presentation of a health emergency plan model applicable to the hospital pharmacy in times of crisis, and the description of the Moroccan National Institute of Oncology's pharmacy experience in fighting COVID-19 pandemic. Method Establishment of a set of procedures for pharmaceutical organization as a part of a health emergency plan, the creation of a device whose endowment allows the rapid management of 25 simultaneous patient's health care, and a system for managing the risks of shortages. In addition, all the missions carried out by the pharmacy during the COVID-19 pandemic were presented and discussed. Results Three medical endowment lists of essential therapeutic products were created, with a total of 125 references. The terms of supplies are defined by a procedure for deploying health emergency plan's pharmacy. An interhospital pharmaceutical inventory monitoring system was also put in place during the COVID-19 pandemic. Conclusion In time of crisis, supply systems are severely disrupted and shortages in therapeutic products are common. An emergency plan is an organization of multidisciplinary actions to deal with a health disasters in which the hospital pharmacy plays a decisive role.

Impact of the COVID-19 pandemic on drug-related problems and pharmacist interventions in geriatric acute care units.

OBJECTIVES: To assess and compare the pharmaceutical analysis on drug management in a geriatric acute care unit prior to and during the COVID-19 pandemic. METHODS: This was a single-centre, retrospective, and comparative cohort study. All Pharmacist Interventions (PIs) carried out in the unit between 27 January 2020 and 30 April 2020 were distinguished according to whether they were conducted prior to or during the first wave of COVID-19. The main outcome measure was the rate of PIs per patient and per prescription lines analysed. Other data collected were the drug class managed by the PI, the Drug Related Problems (DRP) identified, the nature of the advice given, and the acceptance rate by geriatricians. RESULTS: A total of 355 patients were analysed, with PIs generated for 21.7% of the patients prior to COVID-19, and for 53.4% of the patients during the first wave (p<0.001). Among the 4402 prescription lines analysed, 54 PIs were carried out for prescriptions prior to COVID-19, and 177 during the first wave (p=0.002). DRPs were mostly related to anti-infectious drugs during the pandemic (20.3%, p=0.038), and laxatives prior to the pandemic (13.0%, p=0.023). The clinical impact of the PIs was mainly moderate (43.7%). The acceptance rate was 59.3%. CONCLUSIONS: A greater amount of DRPs were detected and more therapeutic advice was proposed during the first wave of COVID-19, with a focus on drugs used for the management of COVID-19 rather than geriatric routine treatments. The needs for clinical pharmacists were strengthened during the pandemic.

[Engagement of students enrolled in fifth year of pharmacy studies in their academic or salaried pharmaceutical activities during the first period of lockout due to the COVID-19 pandemic (16th March-11th May 2020)]. / Engagement d'étudiants de cinquième année de pharmacie dans leurs activités pharmaceutiques, académiques et salariées, au cours de la première période de confinement liée à la pandémie de COVID-19 (16 mars­11 mai 2020).

OBJECTIVES: To characterize the engagement of students enrolled in the fifth year of pharmaceutical studies in the management of the health crisis due to the COVID-19 pandemic, and to identify some determinants of this engagement during this period. METHODS: With the health crisis, new missions have been entrusted during hospital internships, whereas certain internship sites were removed in hospitals and as part of the health service organization. In addition, some students who were no longer in internship returned to the hospital setting for helping in critical activities. Student engagement was studied with a questionnaire and focus groups including six or seven students in each group. RESULTS: Forty-three students participated to the study. The answers to the questionnaire highlighted that they were engaged, that they usually did not wait for compensation, and that most of them were satisfied by their activity during the crisis. The thematic analysis demonstrated that despite a feeling of frustration, which was often associated with the interruption of rewarded activities, and despite a stress due to the particular context, student engagement was supported by a better consideration of the pharmacist's role as a professional in public health and by a better acknowledgement of this role by other health professionals. CONCLUSION: This level of engagement is particularly encouraging because it is the witness of the ability of pharmacists to mobilize for general interest, even in adverse context.

[COVID-19, drugs and hospital pharmacy]. / Évolution des traitements médicamenteux en cas de Covid-19.

Observation, interpretation, actions for improvement, questioning are all terms that echo the situation of caregivers since the outbreak of the COVID-19 epidemic in France at the beginning of 2020. All those involved in the healthcare chain have had to cope with the influx of patients and to show that they are capable of seeing their practices evolve on a daily basis. What was recommended a few weeks earlier could quickly become obsolete. It was necessary to be reactive and the question of drug treatments was at the heart of the concerns, requiring prescribers to keep themselves informed and pharmacists to be as mobilized as possible to respond to requests from the field as quickly as possible.

[Contribution of a hospital pharmacy team to critical care of patients infected with SARS-CoV-2]. / Contribution d'une équipe de pharmacie hospitalière à la prise en charge en réanimation des patients infectés par le SARS-CoV-2.

With regard to the hospital drug supply chain, the safest system is the individual automated drug dispensing one provided by the pharmacy. For several years we have been trying to convince hospital decision-makers to set it up. In the meantime, to mitigate the risks of medication errors incurred by patients and caregivers, we have set up several work teams within the care units. These teams, made up of one pharmacist and one or two hospital pharmacy technicians, who notably manage the medicine cabinets in care units. The close collaboration with doctors and nurses developed over the years was a determining factor when it became necessary to provide the newly created additional intensive care units with drugs and medical devices (MDs) in order to cope with the crisis triggered by the SARS-CoV-2 epidemic. Daily monitoring of the drugs consumed by each patient, particularly neuromuscular blocking agents and MDs was a key element in managing stocks and anticipating changes of drugs, packaging and/or devices references. These facts give weight to the Claris report published in France which recognizes that the interactions of pharmacy technicians and pharmacists in the care units have positive effects in terms of quality and safety of patient care. They highlight the dangers to which patients and caregivers are exposed on Saturdays, Sundays and holidays when the pharmacy is closed. They legitimize the question of extending the opening of the pharmacy with a full team 365 days a year.

[Management of flows and supply shortages of health products in hospitals during the COVID-19 crisis]. / Gestion des flux et des tensions sur les produits de santé à l'hôpital en temps de Covid-19.

The hospital pharmacy is a medico-technical department within the hospital which has been significantly affected by the COVID-19 crisis. It has been a crucial element in the supply and flow management of medicines and medical devices. The shortage of medicines, and in particular of five molecules essential for the treatment of COVID-19 patients, has resulted in stocks being managed on a national level in order to address these new and unknown challenges. Adaptability will remain the key word to describe the action of hospital pharmacies during this crisis.

[Summary]. / Covid-19 : contribution d'une pharmacie hospitalière à la gestion de crise.

France was strongly impacted by the COVID-19 pandemic with nearly30.000 deaths at the end of June 2020. Referent in infectiology, Begin military teaching hospital has contributed to the management of infected patients. The hospital pharmacy has been fully mobilized in the management of the crisis.

The role of the critical care pharmacist during the COVID-19 pandemic.

On January 4 2020, the World Health Organization (WHO) reported the emergence of a cluster of pneumonia cases in Wuhan, China due to a new coronavirus, the SARS-CoV-2. A few weeks later, hospitals had to put in place a series of drastic measures to deal with the massive influx of suspected COVID-19 (COronaroVIrus Disease) patients while securing regular patient care, in particular in the intensive care units (ICU). Since March 12th, 77 of the 685 COVID-19 patients admitted to our hospital required hospitalization in the ICU. What are the roles and the added-value of the critical care pharmacist during this period? His missions have evolved although they have remained focused on providing health services for the patients. Indeed, integrated into a steering committee created to organize the crisis in the intensive care units, the role of the clinical pharmacist was focused on the organization and coordination between ICU and the pharmacy, the implementation of actions to secure practices, to train new professionals and the adaptation of therapeutic strategies. He participated to literature monitoring and increased his involvement in the clinical research team. He provided a link between the ICU and the pharmacy thanks to his knowledges of practices and needs.