[Pharmaceutical analysis and validation of hospital prescriptions, a 5-year study]. / Validation pharmaceutique des prescriptions hospitalières. Intervention et analyse sur cinq ans.

BACKGROUND: Analysis and validation of hospital prescriptions by the pharmacy department, although mandatory since 1991, appears relatively uncommon. Little is known of the nature and frequency of the actions taken by clinical pharmacists during this process. OBJECTIVE: To describe the nature and frequency of pharmaceutical interventions in a large university hospital. METHODS: We reviewed interventions during the pharmaceutical analysis of prescriptions in a surgical ward, a general medical ward and a short-stay hospital unit over a 5-year period. RESULTS: Pharmacists took some type of action in 1438 of the 13,760 prescriptions analyzed (10.4%). Drug interactions accounted for 30.9% of the interventions; 20.2% concerned dose adaptation in cases of renal insufficiency; 13.8% proposed a change from injectable to oral drugs; and 4.1% concerned the physicochemical incompatibility of the simultaneous administration of two drugs through the same infusion line. Drug interactions most frequently involved oral fluoroquinolones and anticoagulants. Dose adaptation was suggested most often for amoxicillin, buflomedil, ofloxacin and allopurinol, while the pharmacists most often proposed changing mixtures of multivitamins, omeprazole, imidazole derivatives and fluoroquinolones from parenteral to oral administration. Physicochemical incompatibility was most frequently associated with furosemide or nicardipine and with antibiotics. CONCLUSION: The analysis of prescriptions by a pharmacist is useful for medical teams: it helps to modify common attitudes towards prescribing drugs and contributes to their appropriate use and to the prevention of adverse events.

[Evaluation of drug therapy knowledge in liver transplant patients after pharmacy counseling]. / Evaluation de l'apport d'une consultation de pharmacie sur les connaissances des patients transplantés hépatiques.

The analysis of the literature demonstrated that pharmacy counselling influenced patient outcome after transplantation. This was the reason we established pharmacy consultation in 1999. The aim of this study was to determine patient knowledge before and after pharmacy counselling. Twenty-nine patients were questioned about the identification, role and dosage of prescribed drugs. The mean duration of pharmacy counselling was 54 minutes. Before pharmacy consultation, the knowledge score was 53.7%. Afterwards, the mean score value reached 75% and seven patients had a score of 100%. The anti-rejection therapy was understood by 93% of patients. However, the associated drugs were poorly known: less than 15% of patients initially knew about the purpose of the antimicrobial agent, compared with 50-60% after counselling. During counselling, two women were identified as regularly using St John's Wort and were informed that this herbal medicine can endanger the success of organ transplantation. Five patients or family members called the pharmacist to obtain additional information. Among these, two medication errors, both with corticosteroid drugs, were reported by family members of patients of foreign origin who had difficulty in understanding and speaking French. Pharmacy counselling improved patient knowledge about therapy after transplantation.

[Clinical trials and outpatient dispensation: the pharmaceutical counseling place]. / Dispensation ambulatoire du médicament pour essai clinique: place du conseil pharmaceutique.

Drug dispensations in clinical trials essentially concern outpatients (90%), and several mistakes and bad uses have been noted. The aim of this work is to set up a pharmaceutical counselling for outpatients in clinical trials. The bibliographic research on this subject did not learn us about similar experiences, but several references helped us to select the support of information: personal meeting between patient and pharmacist to introduce a written leaflet. Pharmaceutical information mentioned in the leaflet has to be validated and has to respect the clinical trials regulations. In the same way, information does not interfere with the inclusion-exclusion criteria or with the physician's observations. Then, information has been deliberately limited to the practical aspects of medications. Anonymous questionnaires have been delivered to the thirty first patients concerned to value their satisfaction with our services. The need of a clear and practical pharmaceutical counselling in clinical trials has been clearly established. Such a pharmaceutical counselling in clinical trials is one component of the overall drug-use process and potentially increases drug compliance. This pharmaceutical counselling on drug management has been well accepted by patients and has been supported by physicians and clinical trial sponsors.