[Malignant hypertension and cardiac decompensation after overuse of nasal decongestant: A case report and literature review]. / Hypertension artérielle maligne et décompensation cardiaque globale après consommation abusive de vasoconstricteur par voie nasale : à propos d'un cas et revue de la littérature.

INTRODUCTION: Vasoconstrictors, widely prescribed in the congestive states during acute rhinitis, are responsible for many cases of drug-related iatrogenic disease. CASE REPORT: We report the case of a 40-year-old man, who presented with an episode of malignant hypertensive crisis associated with life-threatening congestive heart decompensation. The patient interview revealed consumption to supra-therapeutic dosage of an association of naphazoline and prednisolone nasal sprays. The diagnostic work-up allowed to rule out disease-related causes of secondary hypertension. The drug-related disease was thus retained. CONCLUSION: The results of the literature review showed many cases of vasoconstrictor poisoning responsible for central nervous system and cardiovascular involvement, especially in young children. This first case of heart failure related to nasal decongestant administration increases the scope of potentially serious risks of these drugs and demonstrates the outreach needs for health professionals and patients about their proper use.

[Audits of good practice: implantable medical devices are also concerned]. / Audits de bon usage : les dispositifs médicaux implantables sont aussi concernés.

INTRODUCTION: Within the framework of a good practices agreement, French hospitals must perform clinical audits of costly molecules and implantable medical devices (IMD) to justify their medical costs. We present two examples of clinical audits of IMD: hip arthroplasties and cardiac stimulators. PATIENTS AND METHODS: The clinical audits were managed by the pharmacy with the support of the medical teams. Retrospective evaluation of patient files was performed by a pharmaceutical team using evaluation grids developed from official references from the French National Authority for Health and French National Health Insurance. RESULTS: The audit of hip arthroplasty procedures, including a retrospective and prospective study, showed that 95.4% and 96.9% of the surgical procedures followed guidelines. The audit of cardiac stimulators showed 100% agreement with guidelines. The audit of traceability showed that 97% of the files were complete. DISCUSSION: These audits show that the cost increases of the IMD are linked to following guidelines. It is important for these audits of pertinent use to be performed by both physicians and pharmacists. CONCLUSION: There is very little information in the literature or from authorities to help implement these audits. It would be interesting to propose common prospective and retrospective methods to evaluate the pertinent use of IMD.

[Repackaging drugs in pill-box in France: an illegal activity for pharmacists?]. / Le déconditionnement/reconditionnement des spécialités pharmaceutiques en pharmacies : un acte illégal ?

Drug repackaging in pill-box by pharmacists is booming since few years. However, repackaging processes needed to open the industrially primary packaging will be found illegal in France. Thus, in this country drug repacking remains legal only by overwrapping medicines. Now, this solution is not applicable for example, with divisible or liquid forms. Therefore, packaging recommendations must be taken immediately in order to preserve the quality of drugs dispensed and to obtain a legalization of this activity.

[Severe toxicity following capecitabine administration because of dihydropyrimidine deshydrogenase (DPD) deficiency]. / Toxicité sévère à la capécitabine liée à un déficit enzymatique en dihydropyrimidine déshydrogénase (DPD).

Capecitabine is an anticancer agent, prodrug of 5 fluorouracil (5-FU) administered orally and with a narrow therapeutic index. In gastrointestinal cancer, capecitabine is indicated for the treatment of colorectal cancer and metastatic unresectable gastric cancer. The 5-FU is active by incorporation in the biosynthesis of nucleic acids. Inhibition of endogenous synthesis of thymidine is the main way of toxicity of 5-FU. 5-FU is metabolised by the dihydopyrimydine dehydrogenase (DPD). Patients with a DPD deficiency can experience severe toxicity of 5-FU. We report the case of a patient who presented signs of major toxicity justifying hospitalization in intensive care unit 11 days after capecitabine initiation. Investigations showed that he had a DPD deficiency. This case leads to explain the different biological ways to identify patients at risk of developing severe toxicity following capecitabine administration because of DPD deficiency. Is it possible to make a systematic screening before initiation of treatment with 5-FU or prodrug of 5-FU?

[Economic impact of pharmacist's interventions: illustration in a rheumatology ward]. / Impact économique des interventions pharmaceutiques: quelle problématique? Illustration en Service de Rhumatologie.

BACKGROUND AND OBJECTIVE: Drug-related problems represent a major problem for public health. Beyond the health consequences, we have to take into account the cost of these events. Clinical pharmacy services represent a way to tackle this problem. The objective of this study was to perform a cost minimization study on clinical Pharmacist intervention (CPI) in a Rheumatology ward from a General hospital. METHODS: During 16 months, CPIs developed in this unit were codified through an instrument proposed by the French Society of Clinica Pharmacy, and avoided costs on Drug acquisition, Medica Devices and working time of nurses were estimated. RESULTS: 610 pharmaceutical interventions were listed during 64 weeks. Among these interventions, 155 resulted in directs savings. 5,940 euro were saved over the period of data collection for an investment of 10,560 euro for pharmacist time. 90% of avoided costs were in these four categories: intravenous to oral administration conversion (44%); overdose (21%); drugs used without any indication (17%) and prescription duration too long (11%). CONCLUSIONS: The mode is based on the rate of acceptance by the physicians of pharmacist recommendations and the impact time (average length of stay). CPI prevents unnecessary costs but should be followed by other partnerships pharmacy-care units to generate benefits in the current economic context.

[Adverse effects and medication errors: incidence and role of the organization of drug distribution]. / Effets indésirables et erreurs de médication: incidence et rôle de l'organisation du circuit du médicament.

The true incidence of adverse drug events is controversial and there are few data concerning the percentage of potentially preventable adverse drug events. Over 2 months, in two internal medicine units, we asked the staff to report adverse drug events. All incidents were evaluated: adverse drug events (preventable and non-preventable) and potential adverse drug events (non-intercepted potential adverse drug events and intercepted potential adverse drug events). The severity, the stage in the process at which the error occurred and the type of error were evaluated by a physician reviewer. Over the 240 admissions, the incidence of adverse drug events is 18 per 1000 patient-days. The system design caused 77 per cent of the incidents. The medication errors occurred at all stages from ordering to administration. Adverse drug events resulting in medication errors (n = 22) were more serious than non-preventable adverse drug events (n = 26) (p = 0.003). A prevention strategy by pharmacovigilance centres (Centres Régionaux de Pharmacovigilance) should target all stages of the drug delivery process.

Evaluation of prescription-writing quality in a French university hospital.

OBJECTIVE: To evaluate the quality of prescription writing at a university hospital in France. DESIGN/PATIENTS: Each of the 42 medical, surgical, and intensive-care departments were invited to participate in the study. The initial medication orders were reviewed for 866 patients, resulting in 3,254 medications prescribed. One prescription per patient was reviewed for a total of 866 patients, presenting 3,254 medications. RESULTS: Of the 866 prescriptions reviewed, 95.5% were dated. Patient identification was complete in 35.3%. The prescriber was identified properly by both full name and signature in 7.5% of prescriptions. Medication information was complete in only 24% of cases. CONCLUSION: This study showed that prescriptions were not written correctly. Results of this study have been disseminated, and education has begun on proper prescription practice.

Implementation of a documentation management system for quality assurance in a university hospital.

Development and implementation of guidelines constitutes the basis of quality management systems for any organization. The authors have studied the internal documentation produced by professionals on 88 functional units of a university hospital. Reveals the existence of many documents concerning quality of care with an average of 102 available procedures or protocols per unit. However, this documentation is badly organized, making it difficult to consult and to put into practice. The results of this study were provided to other professionals at our hospital in order to make them aware of the necessity of rigorous document management. We have also written and sent recommendations for drawing up procedures and implementing an efficient documentary management system. This effort complements development of the hospital quality assurance plan.

[Study of the quality of prescribing drugs in hospitals]. / Etude de la qualité de la formulation des prescriptions médicamenteuses à hôpital.

The quality of prescription writing has been evaluated in respect of standards of good practice. Among the 44 medical departments of a university hospital, 39 agreed to participate in the study. A sample of 30 patients from each participating department was randomized out of one year's hospital stays; 790 patient records were relevant and have been analysed. The patient's identification was completed in 39.1 +/ 3.4 per cent. THe prescriptor was properly identified by name and signature in 7.2 +/ 1.8 per cent of prescriptions studied. Only 8.9 +/ 2.1 per cent of prescriptions contained the required information for each medication. Results of this study have been sent to all hospital physicians with recommendations for good prescription practice. This evaluation constitutes the first stage of a quality process based on the awareness and information of concerned actors and follow up of specific indicators.