[Comparative study of production and control processes of parenteral nutritional admixtures in neonatology]. / Étude comparative des processus de production et de contrôle analytique des préparations magistrales de mélanges nutritifs parentéraux en néonatalogie.

OBJECTIVES: To assess the impact of disparities in production and analytical control processes on the quality of parenteral nutrition (PN) preparations produced in the Auvergne-Rhône-Alpes region. METHODS: This study was carried out in four hospital pharmacies of the Auvergne-Rhône-Alpes region. To assess the impact of production processes, each centre produced ten PN preparations from the same prescription. Analytical controls (sodium, potassium and calcium dosage) were carried out on all the preparations. To assess the impact of the control processes, a batch of ten preparations was produced from the same prescription. Samples were sent to the four hospital pharmacies for analytical control (sodium, potassium and calcium dosage). RESULTS: Measurements of relative production bias show that there is a significant difference between the preparations from the four centres in terms of sodium and potassium content. Each centre had at least one production bias for one of the three electrolytes measured. Concerning analytical controls, there was a significant difference between the four centres in the sodium and potassium levels measured. With the exception of calcium, all the centres reported measurements within the usual specifications of±10% of the target value. The results obtained have no clinically significant impact. CONCLUSION: The diversity of NP practices has a real impact on the quality of the preparations made. A regional collaboration should be envisaged to standardise patient care.

[Region-wide professional practice evaluation with regards to antiemetic prescription into chemotherapy-induced nausea and vomiting]. / Évaluation régionale des pratiques professionnelles sur l'utilisation des antiémétiques chez les patients atteints de cancer.

The anticancer drug technical commission (COTECH) of the Auvergne OMEDIT has set up a region-wide professional practice evaluation (PPE) with regards to antiemetic prescription practices in chemotherapy-induced nausea and vomiting (CINV), in order to evaluate their compliance with OMEDIT's guidelines. Are not included pediatric and hematologic protocols. A prospective survey was carried from November 2013 to January 2014 out in 14 medical centers in Auvergne. This clinical audit was based on the HAS (national healthcare authority) framework and used as a reference regional standards based on the MASCC Antiemetic Guidelines. Altogether, 346 antiemetic prescriptions were compared to guidelines. We observed respectively 81 % and 42 % conformity rates in acute and delayed emesis for high emesis risk chemotherapy (HE); 86 % and 35 % conformity rates in acute and delayed emesis for moderate emesis risk chemotherapy (ME); 66 % and 85 % conformity rates in acute and delayed emesis for low emesis risk chemotherapy (LE). These results highlight deficiencies in compliance with guidelines, especially in the management of delayed CINV in HE and ME chemotherapy. The COTECH identified three priority improvement areas: under-prescribe NK1 antagonists in HE cure; under-prescribe corticosteroid; over-prescribe 5HT3 antagonists for delayed emesis. The COTECH is publicizing these results all over the Auvergne region, together with a reminder of recommendations.