[Crushing or opening medication: what practices, what risks?] / Écrasement ou ouverture des médicaments : quelles pratiques, quels risques ?

The practice of crushing tablets or opening up capsules to be taken orally, when it is not prescribed, can affect the efficacy of a treatment, or even cause an adverse event. A survey carried out in 2016 revealed that this is a common practice, especially among elderly people. However, alternative forms exist and can be prescribed.

[Elderly hospitalised people and walking capacities]. / Personnes âgées hospitaliséeset capacités de marche.

Falls in the elderly are frequent. A study carried out over 6 months in a university hospital's acute geriatric unit highlighted the real walking capacities of hospitalised elderly people. It also changed the perception of caregivers, doctors and nurses with regard to the real physical aptitudes of these patients enabling the risk of falls to be reduced in preparation for their return home or to a residential care home.

Study on daptomycin use and implementation of an antimicrobial stewardship program.

BACKGROUND: Treatment of Gram-positive pathogens remains a major health issue due to the presence of methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus spp. Daptomycin offers an alternative after therapeutic failure using glycopeptides. Yet its use requires strict control given its financial impact and environmental risks. Since 2014, the use of daptomycin within our hospital has intensified, occasionally outside the scope of its approved indications. OBJECTIVES: The aim of this study is to analyze the appropriateness of daptomycin prescriptions. SETTING: This work was conducted in a 1500-bed University Hospital. METHOD: A descriptive retrospective study was conducted from November 2013 to July 2014. All patients having received at least 2 days of treatment were included. Analysis of the appropriateness of daptomycin prescriptions was conducted by a multidisciplinary team comprised of infectious diseases specialists, pharmacists and a microbiologist. The appropriateness of daptomycin prescriptions was established based on Infectious Diseases Society of America recommendations published in 2011. MAIN OUTCOME MEASURES: The indicators chosen to determine appropriateness of prescription were: treatment indication, prescribed dose and other antibiotics associated with the daptomycin prescription. RESULTS: 19 patients (14 men/5 women) were included. Observed indications were: bone and joint infection (n = 6; 32 %), infectious endocarditis (n = 5; 26 %), bacteremia (n = 5; 26 %) and complicated skin and soft tissue infection (n = 3; 16 %). Identified pathogens were: MRSA (n = 14; 74 %), methicillin-resistant coagulase-negative Staphylococcus (n = 4; 21 %) and Streptococcus mitis (n = 1; 5 %). Daptomycin was prescribed as first-line treatment in 32 % of cases (n = 6). The mean dosage was 9 mg/kg/day (5-11 mg/kg/day) for a mean duration of 11 days (2; 55 days). Clinical success was observed in 42 % of cases (n = 8). Appropriateness for daptomycin use was only established for 15 % of prescriptions (n = 3). CONCLUSION: Faced with a lack of recent recommendations on the subject, our multidisciplinary team issued a local consensus, defining the indications and dosage modalities for this reserve antibiotic. This multidisciplinary approach enables improved use of recent anti-MRSA drugs.

[Securing the use of thermosensitive drugs]. / Sécuriser l'usage des médicaments thermosensibles.

The safety of patient care entails complying with the temperature requirements for thermosensitive drugs. Field studies carried out at the CHU de Caen University Hospital have demonstrated that patients and caregivers do not understand the critical aspect of thermosensitive drugs. This observation has led to the development of tools designed to secure the cold chain for thermosensitive drugs and to increase awareness among healthcare professionals.