[Security in medication use process: state-of-play report in 21 hospital pharmacies in Aquitaine (France)]. / Sécurité du circuit du médicament: état des lieux dans 21 pharmacies à usage intérieur en Aquitaine (Projet SECURIMED).

BACKGROUND: Failures may occur in each part of the medication use process. This study aimed to evaluate the barriers existing in hospital pharmacies in order to prevent medication errors and to help institutions to make improvement actions. METHODS: Within the framework of the SECURIMED project, risk assessment visit (interviews, observations, analysis of adverse event scenario by professionals...) were conducted in volunteer hospital pharmacies. A restitution meeting, after visit in each pharmacy permitted exchanges between visitors and professionals on barriers and weaknesses and then on solutions to reduce identified risks. RESULTS: Twenty-one hospital pharmacies participated. Despite presence of safeguards in some pharmacies, many weaknesses were retrieved (multiplicity of process, lack of resources...) and clinical pharmacy was not enough developed. CONCLUSION: This project has led to an overview of the situation in Aquitaine, and created a regional dynamic to improve the medication system safety.

French national survey of inpatient adverse events prospectively assessed with ward staff.

OBJECTIVES: To estimate the incidence of adverse events in medical and surgical activity in public and private hospitals, and to assess the clinical situation of patients and the active errors. DESIGN: Prospective assessment of adverse events by external senior nursing and doctor investigators with ward staff. SETTING: Random three-stage stratified cluster sampling of stays or fractions of stay in a 7-day observation period for each ward. PARTICIPANTS: 8754 patients observed in 292 wards in 71 hospitals, over 35,234 hospitalisation days. MAIN OUTCOME MEASURES: Number of adverse events in relation to number of days of hospitalisation. RESULTS: The incidence density of adverse events was 6.6 per 1000 days of hospitalisation (95% CI 5.7 to 7.5), of which 35% were preventable. Invasive procedures were the source of half the adverse events, of which 20% were preventable. Adverse events related to the psychological sphere and pain were mostly considered as preventable. Ward staff found it difficult to assess the role of care management in the occurrence of adverse events: 41% of adverse events were expected because of the disease itself, and could have occurred in the absence of the related medical management. CONCLUSION: At the national level in France, every year 120,000-190,000 adverse events during hospitalisation can be considered as preventable. Areas such as perioperative period and geriatric units should receive closer attention. As adverse events occurred more commonly in vulnerable patients, who are not specifically targeted by clinical guidance, practising evidence-based medicine is not likely to prevent all cases. Therefore clinical risk management should prioritize empowerment of local staff, provision of favourable conditions within the organisation, and staff training based on simple tools appropriate for ward-level identification and analysis of adverse events.

Comparison of three methods for estimating rates of adverse events and rates of preventable adverse events in acute care hospitals.

OBJECTIVES: To compare the effectiveness, reliability, and acceptability of estimating rates of adverse events and rates of preventable adverse events using three methods: cross sectional (data gathered in one day), prospective (data gathered during hospital stay), and retrospective (review of medical records). DESIGN: Independent assessment of three methods applied to one sample. SETTING: 37 wards in seven hospitals (three public, four private) in southwestern France. PARTICIPANTS: 778 patients: medical (n = 278), surgical (n = 263), and obstetric (n = 237). MAIN OUTCOME MEASURES: The main outcome measures were the proportion of cases (patients with at least one adverse event) identified by each method compared with a reference list of cases confirmed by ward staff and the proportion of preventable cases (patients with at least one preventable adverse event). Secondary outcome measures were inter-rater reliability of screening and identification, perceived workload, and face validity of results. RESULTS: The prospective and retrospective methods identified similar numbers of medical and surgical cases (70% and 66% of the total, respectively) but the prospective method identified more preventable cases (64% and 40%, respectively), had good reliability for identification (kappa = 0.83), represented an acceptable workload, and had higher face validity. The cross sectional method showed a large number of false positives and identified none of the most serious adverse events. None of the methods was appropriate for obstetrics. CONCLUSION: The prospective method of data collection may be more appropriate for epidemiological studies that aim to convince clinical teams that their errors contribute significantly to adverse events, to study organisational and human factors, and to assess the impact of risk reduction programmes.

[Assessment of pain in elderly hospitalised patients. A transversal descriptive survey]. / Evaluation de la douleur des personnes âgées hospitalisées. Enquête descriptive transversale.

INTRODUCTION: The assessment and treatment of pain in elderly hospitalised patients are essential elements for the management of these patients. Within the context of a policy aimed at fighting against pain, a transversal survey was conducted at the university hospital centre in Bordeaux to enhance knowledge on pain, its impact and the difficulties in its assessment in these elderly patients. OBJECTIVE: Analyse the data of this survey concerning patients aged 65 and over, hospitalised in various departments of medicine and in the Geriatric centre. METHODS: In this "on a given day" transversal survey, 221 patients underwent self-assessment of their pain using a questionnaire and the numerical scale. 365 patients with cognitive or phasic disorders were assessed using a behavioural scale (Doloplus). The prevalence of pain was calculated in the various departments. The type of pain, its impact, its acknowledgment by the nurses and the physicians and the treatments were described. RESULTS: The prevalence of pain was of 47.5% in the patients who underwent self-assessment. In the patients who underwent a hetero-assessment, it was of 63.6% in Medicine and 20% in the Geriatric centre. Acute pain predominated in medicine (49%) and chronic pain in the Geriatric centre (52%). The impact of pain on morale was moderate or severe in 60% of patients, and on sleep in 51%. The simultaneous agreement of the nurses and physicians on the pain felt by the patients was of 32% in Medicine and 44.5% in the Geriatric centre. CONCLUSION: There is a problem in the acknowledgment of pain in elderly patients. This is related to the systematic non-use of assessment tools and the overlooking of rules for the use of analgesics, particularly in the treatment of chronic pain.