ABSTRACT
Prescribing errors related to computerized physician order entry are current and may have serious consequences for patients. They can be detected by pharmacists during prescriptions analysis and lead to pharmacist's interventions. In France, few monocentric studies have studied Pharmacist Interventions triggered by prescribing errors identified as System-Related Errors (PISREs) in French hospitals. However, their respective analysis method prevent any comparison between computerized physician order entry systems in order to identify the safest and rule out the most dangerous. A computerized physician prescribing error related to the software is characterized by its causes, consequences and mechanism of occurrence. US researchers have developed and validated a tool to classify and illustrate these three characteristics. The objectives of this article are to present this tool, to propose a French adaptation and to describe the perspectives analyze and understand prescription errors related to computerized physician order entry based on data of Act-IP©. The adaptation was performed using PISREs extracted from the Act-IP© observatory of the French Society of Clinical Pharmacy. Each item of the codification is illustrated with an example of PI. We are considering a training plan in order to allow wide use of this tool. Once adopted this tool, the next step will be to organize a prospective multicenter study including as many computerized prescription order entry systems as possible. The aim of this study will be identifying the safest systems. Consequently, it will then be possible to have arguments to qualify the most dangerous and thus propose their withdrawal from the market.
ABSTRACT
OBJECTIVES: Computerised physician order entry (CPOE) systems facilitate the review of medication orders by pharmacists. Reports have emerged that show conception flaws or the misuse of CPOE systems generate prescribing errors. We aimed to characterise pharmacist interventions (PIs) triggered by prescribing errors identified as system-related errors (PISREs) in French hospitals. DESIGN: This was a cross-sectional observational study based on PIs prospectively documented in the Act-IP observatory database from January 2014 to December 2018. SETTING: PISREs from 319 French computerised healthcare facilities were analysed. PARTICIPANTS: Among the 319 French hospitals, 232 (72.7%) performed SRE interventions, involving 652 (51%) pharmacists. RESULTS: Among the 331 678 PIs recorded, 27 058 were qualified as due to SREs (8.2%). The main drug-related problems associated with PISREs were supratherapeutic (27.5%) and subtherapeutic dosage (17.2%), non-conformity with guidelines/contraindications (22.4%) and improper administration (17.9%). The PI prescriber acceptation rate was 78.9% for SREs vs 67.6% for other types of errors. The PISRE ratio was estimated relative to the total number of PIs. Concerning the certification status of CPOE systems, the PISRE ratio was 9.4% for non-certified systems vs 5.5% for certified systems (p<0.001). The PISRE ratio for senior pharmacists was 9.2% and that for pharmacy residents 5.4% (p<0.001). Concerning prescriptions made by graduate prescribers and those made by residents, the PISRE ratio was 8.4% and 7.8%, respectively (p<0.001). CONCLUSION: Computer-related prescribing errors are common. The PI acceptance rate by prescribers was higher than that observed for PIs that were not CPOE related. This suggests that physicians consider the potential clinical consequences of SREs for patients to be more frequently serious than interventions unrelated to CPOE. CPOE medication review requires continual pharmacist diligence to catch these errors. The significantly lower PISRE ratio for certified software should prompt patient safety agencies to undertake studies to identify the safest software and discard software that is potentially dangerous.
Subject(s)
Medical Order Entry Systems , Cross-Sectional Studies , Drug Prescriptions , Hospitals , Humans , Medication Errors , PharmacistsABSTRACT
BACKGROUND: The use of controlled substances, especially opioids, is a public health concern. Canada is the country with the second greatest opioid use in the world. The use of these substances is associated with problems of misuse, as evidenced by North America's opioid crisis. OBJECTIVES: To describe and analyze usage patterns for controlled substances in a health care facility from 2003/04 to 2017/18, and to propose a tool for monitoring the use of controlled substances in this setting. METHOD: In this retrospective descriptive study, usage data for all controlled substances were extracted from the institution's supply management software for the period April 1, 2003, to March 31, 2018. The data are presented according to the Anatomical Therapeutic Chemical classification in terms of number of Defined Daily Doses (DDD) per 1000 inpatient-days, using the DDD values proposed by the World Health Organization. Only descriptive statistics were determined. RESULTS: During the last 15 years, use of controlled substances at the study facility dropped by 43% (min. 739 and max. 1292 DDD/1000 inpatient-days per year). From 2003/04 to 2017/18, the main therapeutic classes consumed (in decreasing order) were opioids, hypnotics and sedatives, anxiolytics, and general anesthetics. The main opioid molecules consumed in 2017/18 were hydromorphone and injectable morphine. CONCLUSIONS: This retrospective descriptive study showed a decrease in the consumption of controlled substances in the study facility from 2003/04 to 2017/18. It also demonstrated the feasibility of developing a tool for monitoring the use of controlled substances in a health care facility. This approach could be implemented at a larger scale to foster comparisons between facilities.
ABSTRACT
BACKGROUND: Pharmacists are required to maintain a secure inventory of medications and to ensure proper, safe, and diversion-free dispensing practices. OBJECTIVES: The primary objectives of this study were to determine compliance with recommended practices for the management of controlled substances in a mother-child teaching hospital and to identify actions to improve compliance. The secondary objective was to identify steps in the drug pathway for controlled substances and associated failure modes in the study hospital. METHODS: This descriptive cross-sectional study used a framework developed by the California Hospital Association (CHA) to assess compliance with recommended practices for the management of controlled substances in hospitals. For each criterion, a research assistant observed practices within the pharmacy, on patient care units, at outpatient care clinics, and in operating and delivery rooms. The level of compliance was recorded as compliant, partially compliant, or noncompliant. An Ishikawa diagram was developed to illustrate steps in the drug pathway and associated failure modes related to the use of controlled substances in the study hospital. RESULTS: The pathway for controlled substances at the study hospital was compliant for 56 (49.6%) of the 113 CHA criteria, partially compliant for 27 (23.9%) of the criteria, and noncompliant for 24 (21.2%) of the criteria; the remaining 6 (5.3%) criteria were not applicable. This practice evaluation highlighted 22 corrective actions, 12 (55%) that could be implemented in the short term, 8 (36%) suitable for implementation in the medium term, and 2 (9%) suitable for both the short and medium term. A total of 57 potential failure modes related to the use of controlled substances were identified. CONCLUSIONS: The pathway for controlled substances at the study hospital was compliant with almost half of the CHA criteria, and 22 corrective actions were identified. Pharmacists, physicians, and nurses should be mobilized to optimize the use of controlled substances throughout the drug-use process.
CONTEXTE: Les pharmaciens sont responsables de maintenir à jour les réserves de médicaments et doivent faire en sorte que les pratiques de distribution soient adéquates, sûres et exemptes de détournement. OBJECTIFS: Les objectifs principaux de la présente étude consistaient à déterminer le degré de conformité aux pratiques de gestion des substances contrôlées, recommandées dans un hôpital universitaire mère-enfant, et de trouver des mesures pour améliorer leur degré de conformité. L'objectif secondaire visait à recenser les étapes que suivent les substances contrôlées dans le circuit des médicaments et les modes de défaillance qui y sont associés dans l'hôpital à l'étude. MÉTHODES: La présente étude descriptive et transversale s'appuyait sur un cadre mis au point par la California Hospital Association (CHA), qui sert à évaluer le degré de conformité aux recommandations relatives aux pratiques de gestion des substances contrôlées dans les hôpitaux. Pour chaque critère, un assistant de recherche observait les pratiques dans le service de pharmacie, les unités de soins, les cliniques de consultation externe et les salles d'opération ou les salles d'accouchement. Il évaluait le degré de conformité à l'aide d'un des qualificatifs suivants : conforme, partiellement conforme ou non conforme. Un diagramme d'Ishikawa a été conçu pour illustrer les étapes du circuit des médicaments et les modes de défaillance associés à l'utilisation de substances contrôlées dans l'hôpital à l'étude. RÉSULTATS: Le circuit des substances contrôlées à l'hôpital où se déroulait l'étude était conforme à 56 (49,6 %) des 113 critères de la CHA, partiellement conforme à 27 (23,9 %) critères et non conforme à 24 (21,2 %) critères; les 6 (5,3 %) critères restants n'étaient pas applicables. Cette évaluation des pratiques a mis en évidence 22 actions correctives, dont 12 (55 %) pouvaient être mises en place à court terme, 8 (36 %) à moyen terme et 2 (9 %) à court ou à moyen terme. Les investigateurs ont repéré 57 modes de défaillance potentiels liés à l'utilisation de substances contrôlées. CONCLUSIONS: L'analyse du circuit des substances contrôlées à l'hôpital où se déroulait l'étude a révélé que près de la moitié des critères de la CHA étaient conformes, et 22 actions correctives ont été proposées. Les pharmaciens, médecins et infirmières devraient participer à l'optimisation de l'utilisation des substances contrôlées dans l'ensemble du processus de distribution des médicaments.
ABSTRACT
BACKGROUND: Drug shortages represent a complex global problem affecting patients and health care professionals on a daily basis. OBJECTIVES: To identify, describe, and compare drug shortages in health care facilities in Canada and 4 European countries in early 2018. METHODS: A descriptive cross-sectional study was conducted in 1 hospital in each of 5 countries: Canada, France, Belgium, Spain, and Switzerland. Over a 4-week period, shortage data were collected daily by each hospital using a standardized grid and a standard process. RESULTS: From January 8 to February 2, 2018, there were a total of 84 shortages (median duration 32 days) in the Canadian hospital, 62 shortages (median duration 9 days) in the French hospital, 46 shortages (median duration 37 days) in the Belgian hospital, 28 shortages (median duration 25 days) in the Spanish hospital, and 98 shortages (median duration 68 days) in the Swiss hospital. The number of manufacturers implicated in the shortages was 28 for the Canadian hospital, 30 for the French hospital, 19 for the Belgian hospital, 16 for the Spanish hospital, and 42 for the Swiss hospital. Most of the shortages involved parenteral drugs, with both innovative and generic manufacturers being affected. Most therapeutic classes were affected by shortages to some extent, with the top 3 classes being anti-infective agents (accounting for 21.1% of shortages overall), central nervous system drugs (11.3%), and cardiovascular drugs (8.2%). CONCLUSIONS: Drug shortages occurred almost daily in all of the study hospitals. Across the 5 hospitals, the frequency of shortages varied by a factor of 3, which may imply similar variability at the national level. All stakeholders should work more diligently to prevent and manage drug shortages.
CONTEXTE: Les pénuries de médicaments représentent un problème mondial complexe qui touche quotidiennement les patients et les professionnels de la santé. OBJECTIFS: Recenser, décrire et comparer les pénuries de médicaments ayant eu lieu au début de 2018 dans des établissements de soins de santé du Canada et de quatre pays d'Europe. MÉTHODES: Une étude descriptive et transversale a été menée dans un hôpital de chacun des cinq pays suivants: le Canada, la France, la Belgique, l'Espagne et la Suisse. Sur une période de quatre semaines, chaque hôpital a recueilli quotidiennement les données sur les pénuries à l'aide d'une grille et d'un processus normalisés. RÉSULTATS: Pour la période allant du 8 janvier au 2 février 2018, on a recensé 84 pénuries (durée médiane de 32 jours) dans l'hôpital canadien, 62 pénuries (durée médiane de 9 jours) dans l'hôpital français, 46 pénuries (durée médiane de 37 jours) dans l'hôpital belge, 28 pénuries (durée médiane de 25 jours) dans l'hôpital espagnol et 98 pénuries (durée médiane de 68 jours) dans l'hôpital suisse. Vingt-huit (28) fabricants étaient impliqués dans les cas de pénuries dans l'hôpital canadien, 30 dans l'hôpital français, 19 dans l'hôpital belge, 16 dans l'hôpital espagnol et 42 dans l'hôpital suisse. La plupart des pénuries touchaient les médicaments parentéraux et mettaient en cause tant les fabricants de médicaments novateurs que ceux de médicaments génériques. Les pénuries ont affecté d'une manière ou d'une autre la plupart des classes de médicaments, mais les trois classes les plus touchées étaient les agents anti-infectieux (21,1 %) les médicaments agissant sur le système nerveux central (11,3 %) et les agents cardiovasculaires (8,2 %). CONCLUSIONS: Des pénuries survenaient presque quotidiennement dans chaque hôpital de l'étude. Dans l'ensemble des hôpitaux, la fréquence des pénuries variait selon un facteur de trois, ce qui pourrait se traduire par une variabilité semblable à l'échelle nationale. Toutes les parties prenantes doivent travailler avec plus d'ardeur à la prévention et à la gestion des pénuries de médicaments.
