ABSTRACT
INTRODUCTION: The aim of the study is to identify medication errors related to computerized physician order entry in our hospital. METHODS: At the end of this 1-year study (2008 to 2009), 378 beds were computerized by a business software. Medication errors were identified from notifications sent to the publisher of the software, feedback of health professionals and the analysis of Pharmacists' interventions formulate following prescription errors due to computerization. They were qualified according to the medication error's French dictionary of the French Society of Clinical Pharmacy. RESULTS: Thirty-five categories of medication errors were found. Most of them appear during prescription. Dosage and concentration errors, dose errors, omission errors and drug errors are the most frequent. DISCUSSION-CONCLUSION: Three main causes were found: human factor, closely related to the software settings and the quality of user training; communication problems, related to the ergonomics; conception problems, related to intuitiveness and intricacy of the software. These results confirm the existence of medication errors induced by computerized physician order entry systems. They highlight the need to involve initial and ongoing training of users, relevance and scalability of the setup and use of mature and certified software to minimized them.
Subject(s)
Drug Prescriptions/standards , Medical Order Entry Systems , Medication Errors/prevention & control , Communication , Computers , Pharmaceutical Preparations/administration & dosage , Pharmacists , Pharmacy Service, Hospital , Physicians , SoftwareABSTRACT
In the research of new dosage forms improving the therapeutic index of local anesthetics, we studied cyclodextrins, cyclic oligosaccharides forming soluble inclusion complexes with various lipophilic drugs. Complexes between bupivacaine and hydroxypropyl-B-cyclodextrin, bupivacaine and sulfobutyl ether-7-B-cyclodextrin were studied in vivo, using an epidural and a perineural (sciatic) model, respectively. Biopharmaceutics and pharmacodynamics of bupivacaine were evaluated in the rabbit. In both models, only systemic absorption rate of bupivacaine was decreased upon complexation, not the quantity absorbed. Complexation with cyclodextrins could be a promising drug delivery system to improve the therapeutic index of local anesthetics.
Subject(s)
Anesthetics, Local/pharmacokinetics , Bupivacaine/pharmacokinetics , Cyclodextrins/pharmacokinetics , beta-Cyclodextrins , Anesthetics, Local/administration & dosage , Anesthetics, Local/pharmacology , Animals , Bupivacaine/administration & dosage , Bupivacaine/pharmacology , Carbohydrate Sequence , Cyclodextrins/chemistry , Dosage Forms , Injections, Epidural , Injections, Intravenous , Molecular Sequence Data , Rabbits , Structure-Activity RelationshipABSTRACT
PURPOSE: To investigate the influence of complexation between bupivacaine and hydroxypropyl-beta-cyclodextrin (HP-beta-CD) on the systemic absorption and on the pharmacodynamic effect of bupivacaine following epidural administration in a rabbit model. METHODS: Bupivacaine and bupivacaine-HP-beta-CD complex were administered according to a randomized and cross-over design in six rabbits chronically instrumented with an epidural catheter. The plasma concentrations of bupivacaine and the duration and intensity of the motor blockade were evaluated. RESULTS: Complexation with HP-beta-CD led to a decrease in the maximum plasma concentration of bupivacaine. Individual absorption kinetics evaluated by Loo-Riegelman absorption analysis indicated that systemic absorption resulted from two parallel first-order processes. Only the faster absorption phase was slowed by complexation with HP-beta-CD. The duration of the motor blockade was increased almost twice but the intensity was not modified. CONCLUSIONS: Complexation with HP-beta-CD could be a promising drug delivery system to improve the therapeutic index of bupivacaine.
