[A training medication errors room: simulate to better train health professionals]. / La chambre des erreurs médicamenteuses: simuler pour mieux former.

BACKGROUND: Medication errors (ME) could lead to severe adverse events. Hospital staff have to gain practical knowledge and ME preventing methods. Simulation is a teaching method more and more used in health system. The aim of this study was to create an error patient room which represents a factitious patient room with ME for health professionals of the hospital. METHOD: Chosen according 3 criteria (errors already observed, "never events" related errors, errors associated with frequent issues), 21 ME were designed concerning the different steps of the medication process (prescribing, dispensing and administration) and took place in a patient room reserved for training. Seven sessions were proposed from april to june 2014. All health professionals were invited to participate on a voluntary basis. Training session was not time limit. An individual debriefing was done after each session. RESULTS: Forty-six health professional participated of 13 different hospitals' departments: 7 medicine residents, 26 nurses and 13 persons of the pharmacy staff (8 pharmacy technicians, 3 pharmacy students and 2 pharmacists). EM rate ranged of 33% (medicine residents), 50% (nurses) to 47% (pharmacy staff). DISCUSSION - CONCLUSION: The training ME room represents an easy, useful and reusable simulating tool, to train health professional and to improve their knowledge's and practical methods. This learning tool is developed in order to provide patient safety. This successful study will be evaluated by satisfaction questionnaire. Future sessions will be programmed.

[Individualized pharmaceutical consultations in the management of chemotherapy-induced nausea and vomiting]. / Place des consultations pharmaceutiques individualisées dans la prise en charge des nausées et vomissements chimio-induits.

In order to prevent and control the chemotherapy-induced nausea and vomiting (CINV), the military hospital Percy (Clamart, France) developed a systematic "CINV consultation". With 1.500 consultations conducted in 2013, the aim of this study was to confront professional practices and the patient's point of view to assess the efficiency of this procedure and consider a restructuring to optimize it. A preliminary study was conducted: 30 medical records of patients who had chemotherapy cure during 2013 have been analysed and 30 patients have completed an evaluation questionnaire anonymously. Patients were very satisfied (63%) or satisfied (37%) of these consultations. Most of them (71%) said the consultations were useful before every cure, while 27% thought that the consultation at first cure or when the chemotherapy protocol changed was enough. CINV consultations were estimated as complementary of the medical consultation for 93% of the patients. Most of the patients (70%) never had CINV or just at the first cure. Furthermore, the anti-emetic treatment was adapted to the new chemotherapy emetic level in only 53% of protocol changes. Patients have expressed a real interest in these CINV consultations and the benefits they could get from them. Moreover, patients' side effects are stabilized faster thanks to those pharmaceutical interviews. In fact, it seems that these consultations are mostly needed for the first cure (until patient stabilization) and when there is a chemotherapy protocol change.

[Review of medication errors: a case in an intensive care unit]. / Revue des erreurs médicamenteuses (REMED) : une première en service de réanimation.

OBJECTIVE: The authors conducted for the first time a medication error review (REMED) following a medication error occurred in an intensive care unit. The aim of this study was to assess this first REMED. STUDY DESIGN: Descriptive study. METHODS: The analysis of the medication error, consisting in the administration of Clottafact(®) instead of Aclotine(®), was performed using the REMED method. RESULTS: The medication error was characterized as "proved error" and "missed before administration". Four main causes were identified: poor quality of drug storage, homophony between Aclotine(®) and Clottafact(®), non-compliance with good practices, and need of hemofiltration for the patient. At least, this REMED analysis led to the establishment of four improvements measures. CONCLUSION: The educational aspect of the REMED was clearly appreciated by all the different health care workers who participated to the analysis. Even if medication errors may occur at the different steps of the medication process, the REMED is a very good tool to improve the care quality and also to reduce the drug iatrogenic risk.

Drug administration error related to computerized prescribing.

INTRODUCTION: One of the main reasons for the implementation of computer-based prescribing was to reduce medication errors. However, the risk has not fallen to zero and new kinds of errors have been detected. SETTING: the following case relates one of these medication errors involving a preparation of vincristine. This antineoplastic drug was injected to a patient via a subcutaneous route of administration instead of an intravenous bolus injection. RESULTS: consequently, a cutaneous erythema appeared. This incident resulted from an error in the programming of the administration route of the protocol operated by a pharmacist and a physician. The pharmacist, who was responsible for the validation of the computerized medical order and then for the compounding and the dispensing of the drug, did not detect the error. CONCLUSION: this case highlights the need of improved and irreproachable therapeutic protocols. Recorded in a database, they must be validated pharmaceutically and medicinally to secure computer-based prescribing, drug handling, dispensing, and administering of the antineoplastic drugs. Even if the pharmaceutical analysis of prescriptions is made easier with computerization, we encourage the training of nurses and the evaluation of their knowledge as well as the necessity for pharmacists to learn to detect new kinds of errors and to verify periodically protocols.

[Doxycycline]. / La doxycycline.

Doxycycline is a semi-synthetic derivative of tetracycline family exhibiting an interesting pharmacokinetic profile since no dosage adjustment is required for renal failure. Doxycycline displays good bacteriostatic activity against most bacteria as well as anti-inflammatory activity. Bacterial resistance is mainly acquired. Many infectious diseases can be treated with doxycycline including brucellosis, pasteurellosis, borreliosis, rickettsioses, trepanomatosis, cholera, leptospirosis, Q fever, pulmonary and urinary infections due to Chlamydia and Mycoplasma, gonococcia, and anthrax. Doxycycline also prevents development of Plasmodium in the blood and is thus useful for malaria prophylaxis. In dermatology, doxycycline is indicated for acnea and rosacea. Doxycycline is well tolerated. The most frequent adverse effects are stomach upset, nausea, and diarrhea, but new formulations that reduce these manifestations are now available. Phototoxicity is dose-dependant and other side effects are rare. Like other tetracylines, doxycycline is contraindicated in children, pregnant women after the second trimester, and breast-feeding mothers.

[Medication dispensing errors detected in medication cassettes intended for in-hospital patients]. / Erreurs de dispensation des médicaments détectées dans les piluliers destinés aux patients hospitalisés.

BACKGROUND AND OBJECTIVE: Many dispensing errors occur in hospital pharmacies and can harm patients if they are not intercepted. The aim of this study was to determine the incidence and the primary types of medication dispensing errors at a French military hospital. METHOD: The check of unit dose medication cassettes was performed by nurses. From February 2007 to April 2007, detected dispensing errors were systematically recorded and classified into 6 categories: unauthorized drug, wrong dosage-form, improper dose, omission, wrong time, and deteriorated drug errors. The overall error rate was calculated. RESULTS: During the study, 5112 medication cassettes were checked. 106 dispensing errors have been detected by nurses for a total of 45,573 filled (n=45,518) and omitted (n=55) unit doses. An overall error rate of 0.23% was found. There were approximately 0.02 detected dispensing errors per medication cassette. The most common error types were omission errors (n=55, 51.88%) and improper dose errors (n=30, 28.30%). DISCUSSION-CONCLUSION: The results of this study showed that a check performed by nurses after the dispensing process is necessary to detect the dispensing errors. Many causes may explain the occurrence of dispensing errors and must be corrected. Because some dispensing errors may remain undetected, there is a requirement to develop strategies in order to reduce or eliminate these errors, such as the implementation of a computerized prescribing system. The pharmacy staff is widely involved in this duty.

[Alpha emitters inhalation: detection by a process with flags]. / Intérêt de l'évaluation de l'inhalation des émetteurs alpha par la technique des drapeaux.

This work relates to the contaminated people survey (alpha emitters inhalation) with nasal mucus sample analysis. Alpha emitters detection by liquid wander on flags (blotting paper) was employed. Compared to the current technique with paper handkerchiefs, this process improves considerably the time, reduced to 10 min between the sampling's reception and the results of the analysis. The detection's sensitivity of the process is also higher. This process with flags concerns the occupational survey on people leaving an alpha contaminated area (nuclear power plant). It is also available to the monitoring of intervention teams leaving the contaminated area during the immediate response phase and the follow-on response phase (management of the crisis and site restoration).

[Toxic waste and health effects in Abidjan City, Ivory Coast]. / Déchets toxiques déversés à Abidjan (Côte-d'Ivoire) et conséquences sanitaires.

Accidental chemical pollution can have serious effects on human health. In 2006, the tanker vessel Probo Koala discharged hundreds of tons of toxic waste at many sites in Abidjan City, Ivory Coast. In the following days and weeks, thousands of people presented signs of poisoning. Analysis of the waste demonstrated the presence of toxic chemicals such as mercaptans and hydrogen sulfide. The final toll was 8 dead, dozens hospitalized, and about 100,000 seeking medical advice. This event provides evidence that, like international immigration, exportation of industrial waste can result in serious public health hazards.

Dechets toxiques deverses a Abidjan (Cote-d'Ivoire) et consequences sanitaire

La pollution accidentelle par des produits chimiques peut avoir de graves consequences pour les populations humaines. En 2006; le navire Probo Koala decharge plusieurs centaines de tonnes de dechets toxiques dans plusieurs sites de la ville d'Abidjan (Cote d'Ivoire). Dans les jours et semaines qui suivent; des milliers de personnes presen- tent des signes d'intoxication. Les expertises realisees sur les dechets revelent la presence de produits toxiques comme lesmercaptans et l'hydrogene sulfure. Le bilan sanitaire fait etat de huit deces; plusieurs dizaines de personnes hospitalisees et environ 100 000 consultations medicales. Cet episode rappelle qu'a l'instar des deplacements internationaux des personnes; les transfertsmondiaux de dechets industriels peuvent avoir de graves consequences sur le plan sanitaire; en particulier dans les pays du sud

Dechets toxiques deverses a Abidjan (Cote-d'Ivoire) et consequences sanitaires

La pollution accidentelle par des produits chimiques peut avoir de graves consequences pour les populations humaines. En 2006; le navire Probo Koala decharge plusieurs centaines de tonnes de dechets toxiques dans plusieurs sites de la ville d'Abidjan (Cote d'Ivoire). Dans les jours et semaines qui suivent; des milliers de personnes presentent des signes d'intoxication. Les expertises realisees sur les dechets revelent la presence de produits toxiques comme les mercaptans et l'hydrogene sulfure. Le bilan sanitaire fait etat de huit deces; plusieurs dizaines de personnes hospitalisees et environ 100 000 consultations medicales. Cet episode rappelle qu'a l'instar des deplacements internatio- naux des personnes; les transfertsmondiaux de dechets industriels peuvent avoir de graves consequences sur le plan sanitaire; en particulier dans les pays du sud

[Development of novel antihelminthic therapies]. / Nouveautés thérapeutiques dans les traitements antihelminthiques.

Since existing medications are effective, easy-to-use and well tolerated, research in the treatment of helminthiasis in humans seems to be at a standstill. However this type of parasitic infection is still a major public-health concern and heavy socioeconomic burden in many countries. Despite observance of the first disturbing signs of resistance, release of new antihelminthics on the market (e.g. nitazoxanide and tribendimidine) remains slow. Treatment using drug combinations offers an alternative for therapeutic failure in some cases. Ongoing studies focusing on development of a vaccine, on adaptation of medications used in veterinary medicine or on the action of medicinal plants hold forth hope of finding effective new treatments.