[Evaluation of the organisational and clinical impacts of supply chain problems in a university hospital]. / Évaluation des impacts organisationnels et cliniques des ruptures de médicaments au sein d'un centre hospitalier universitaire.

Drug supply problems are a real public health concern. Despite the implementation of legal measures, this problem is still relevant, with potential clinical, organizational and financial consequences in hospitals. The objective is to evaluate the organizational and clinical impact of supply problems in a hospital. A retrospective study of the supply problems encountered in our institution made it possible to classify them according to different criteria using an algorithm. A mapping of the organizational impact of the resolution of each supply problem according to the internal organization of the medication circuit was developed. The potential clinical impact of each problem identified was assessed using a 4-level scale. Over an 18-month period, 332 supply problems were recorded, 78 % of which were classified as a stock-outs. Over the entire study, 2415 organizational impact points were identified, with 2019 impacts for the pharmacy department and 396 impacts for the healthcare departments. Approximately 90 % of the drugs with a supply problem were drugs of major therapeutic interest. In 49 % of the situations, they have a lesser clinical impact as soon as shortage management is put in place. The characterization of the different management methods has made it possible to systematically identify and predict the impact on the entire medication circuit. The impact on the patient is thus limited if the management of the supply problem is well anticipated by the pharmacist. The pharmacist plays an important role in managing supply problems, but also in providing support to the care services.

"When did you decide to receive the Covid-19 vaccine?" Survey in a high-volume vaccination center.

Highly efficient and safe Covid-19 vaccines are available in Europe in amounts that theoretically allow for a high immune coverage. However, a notable proportion of the population is reluctant toward immunization. We aimed to determine, among people who chose to be vaccinated, when they made the decision and whether they would have preferred an earlier vaccination. A survey was conducted in a high-volume Covid-19 vaccination center in France from 28 May to 9 July 2021 through an anonymous questionnaire. The 2519 participants (54.1% males; median age 39 years) attributed lower efficacy and safety to Covid-19 vaccines than to vaccines in general. When asked when they decided to receive the vaccine, 15.5% and 16.0% answered "less than one month ago" and "less than one week ago," respectively; age <40 and female sex were independently associated with these responses. When asked whether they would have preferred to have been vaccinated earlier, 57.6% answered "definitely no," "rather no," or "neither yes nor no"; female sex (independently from age) was associated with these answers. When asked whether they would have preferred to receive the vaccine as early as January 2021, 65.2% answered "definitely no," "rather no," or "neither yes nor no"; age <40 and female sex were independently associated with these responses. In conclusion, one-third people had made the decision to be vaccinated only recently, while more than half would not have preferred an earlier vaccination, in particular women and those aged <40 years. Vaccine campaigns should take such short-term decision-making processes into account.

[Diffusion of pharmacist interventions within the framework of clinical pharmacy activity in the clinical ward]. / Diffusion des opinions pharmaceutiques dans le cadre d'une activité de pharmacie clinique en unité de soins.

BACKGROUND: Computerised physician order entry (CPOE) and the integration of a pharmacist in clinical wards have been shown to prevent medication errors. OBJECTIVES: The objectives were to describe interventions performed by a clinical pharmacist integrated into clinical wards with CPOE, to assess the acceptance of interventions by prescribers, and to describe factors associated with acceptance. METHODS: A 3-week prospective study was conducted in five wards of a 2000-bed French teaching hospital. RESULTS: During pharmacist review of medication orders and participation on physician rounds, six resident pharmacists provided interventions either conveyed orally to prescribers, using the computer system, or combining both methods. There were 221 pharmacist interventions concerning drug-drug interactions (27%), drug monitoring (17%) and computer-related problems (16%). Pharmacist interventions consisted of change of drug choice or dose adjustment (49%), drug monitoring (17%) and administration modality optimisation (14%). Interventions were provided solely via computer systems in 67% of cases. The rate of intervention acceptance was 47.1%. In multivariate analysis, acceptance was significantly associated with oral transmission (odds ratio [OR] = 6.46; 95% confidence interval [95% CI] [1.65-25.24]; p < 0.01), change of drug choice or dose adjustment recommendations (OR = 3.81; 95% CI [1.63-8.86]; p < 0.01) and administration modality optimisation recommendations (OR = 9.51; 95% CI [3.02-29.93]; p < 0.01). CONCLUSION: Communication method and nature of recommendation are factors associated with pharmacist intervention acceptance. CPOE is necessary to develop clinical pharmacy practice. However, only the integration of the pharmacist on the ward can guarantee a high level of acceptance of pharmacist interventions by prescribers.