Evaluation of the impact of pharmaceutical trainings and tools on the proper use of medicines in pediatrics

Introduction: After six years of medication errors' (MEs) collection and analysis in a pediatric unit of a French University Hospital, the number of MEs was no longer decreasing. We then decided to set up pharmaceutical training and tools and evaluate their impact on the occurrence of ME. Materials and methods: This monocentric prospective study was carried out in the form of audits of prescriptions, preparations, and administrations before and after intervention (A1 and A2). After the analysis of A1 results, feedback was given to the teams, some tools for the proper use of medication (PUM) were distributed, and A2 was conducted. Finally, A1 and A2 results were compared. Results: Each audit included 202 observations. A total of 120 MEs were identified during A1 and 54 for A2 (p < 0.0001). The observation rate with at least 1 ME decreased from 39.11% to 21.29% (p < 0.0001), and no observation had more than two MEs during A2 in contrast to A1 (n = 12). Human factors were responsible for the majority of MEs. The audit feedback allowed professionals to feel concerned about ME. The PUM tools received an average satisfaction rating of 9/10. The staff had never participated in this type of training, and all felt it was useful to apply PUM. Conclusion: This study showed a significant impact of pharmaceutical training and tools on the pediatric PUM. Clinical pharmaceutic actions allowed us to reach our objectives and satisfied all the staff. They must, therefore, be continued to limit human factors' impact and thus contribute to the safety of drug management in pediatrics.

Pneumococcal and influenza vaccination coverage of heart failure patients: still a long way to go

 

In patients with heart failure (HF), respiratory infections are responsible for acute exacerbation and increased hospitalization. Vaccination may reduce the incidence and/or severity of respiratory infections, and thereby, reduce the risk of HF exacerbation. Despite current recommendation, vaccination coverage (VC) for patients with HF remains far too limited.

To study the VC of HF patients followed in our hospital and to precise the strategies desired by the patients in order to carry out the vaccination.

This was a prospective monocentric descriptive study conducted between December 2019 and January 2021. Patients with HF history hospitalized in cardiology unit (CU) and patients in a HF telemonitoring program (TP) were included. An interview was conducted by a pharmacist to find out the patient's vaccination status regarding influenza and pneumococcus, together with socio-demographic clinical data. During the interview for non-vaccinated patients, opinion and willingness to be vaccinated were obtained.

Data from 335 patients were collected (185 in CU, 150 in TP). The mean age was 69.3 years, and sex ratio was 2.6. About 65% were vaccinated against influenza in the last year (60% in CU, 72% in TP, p=0.022) and 22% had pneumococcal vaccination in the last 5 years (11% in CU, 35% in TP, p&lt;0.001). Respectively 64% of patients with HF with reduced ejection fraction (HFrEF) and 67% of patients with HF with preserved ejection fraction (HFpEF) were vaccinated against influenza (p=0,63) against 25% of patients with HFrEF and 19% with HFpEF for pneumococcus (p=0,27). 68% of the patients were in favour of the vaccination, 23% had a mixed opinion and 9% were against it. Among patients not vaccinated against influenza or pneumococcus, 17% refused to be vaccinated. Among unvaccinated patients who consider vaccination, 69% wanted to be vaccinated by their general practitioner (GP) and 7% wanted to be vaccinated by their cardiologist. Almost 1/3 of unvaccinated patients who were included in CU wanted a vaccine prescription at discharge. Among the vaccinated patients, information on the need to be vaccinated had been provided to them mostly by health insurance (73%) and their GP (19%) for the influenza vaccine and by their cardiologist (55%) and GP (32%) for the pneumococcal vaccination.

The VC of HF patients remains insufficient, particularly against pneumococcus, as described by Kopp and al. Patients in TP are more vaccinated than patients in CU, which could involve better management. Moreover, the low rate of vaccinated patients is mainly explained by a lack of awareness, as most of the unvaccinated would like to be vaccinated. About 2/3 of patients wanted to be vaccinated by their GP, and thus play a major role in their global care. The higher vaccination rate for influenza, which unlike pneumococcus benefits from a national vaccination campaign, demonstrates that improvements are needed in the institutional promotion of vaccination for HF patients.

Funding Acknowledgement

Type of funding sources: None.

Medication errors at hospital admission and discharge in Type 1 and 2 diabetes

AIMS

To assess the prevalence and characteristics of medication errors at hospital admission and discharge in people with Type 1 and Type 2 diabetes, and identify potential risk factors for these errors.

METHODS

This prospective observational study included all people with Type 1 (n = 163) and Type 2 diabetes (n = 508) admitted to the Diabetology-Department of the University Hospital of Montpellier, France, between 2013 and 2015. Pharmacists conducted medication reconciliation within 24 h of admission and at hospital discharge. Medication history collected from different sources (patient/family interviews, prescriptions/medical records, contact with community pharmacies/general practitioners/nurses) was compared with admission and discharge prescriptions to detect unintentional discrepancies in medication indicating involuntary medication changes. Medication errors were defined as unintentional medication discrepancies corrected by physicians. Risk factors for medication errors and serious errors (i.e. errors that may cause harm) were assessed using logistic regression.

RESULTS

A total of 322 medication errors were identified and were mainly omissions. Prevalence of medication errors in Type 1 and Type 2 diabetes was 21.5% and 22.2% respectively at admission, and 9.0% and 12.2% at discharge. After adjusting for age and number of treatments, people with Type 1 diabetes had nearly a twofold higher odds of having medication errors (odds ratio (OR) 1.72, 95% confidence interval (CI) 1.02-2.94) and serious errors (OR 2.17, 95% CI 1.02-4.76) at admission compared with those with Type 2 diabetes.

CONCLUSIONS

Medication reconciliation identified medication errors in one third of individuals. Clinical pharmacists should focus on poly-medicated individuals, but also on other high-risk people, for example, those with Type 1 diabetes.

Pharmacist intervention to detect drug adverse events on admission to the emergency department: Two case reports of neuroleptic malignant syndrome

WHAT IS KNOWN AND OBJECTIVE

Neuroleptic malignant syndrome (NMS) is a rare but severe adverse effect of antipsychotic drugs.

CASE DESCRIPTION

We report two cases of NMS highlighted by clinical pharmacists in an emergency unit during summer. One of them was fatal. Medication reconciliation processes performed at admission identified treatment with loxapine for one of them and with loxapine and clozapine for the other. Interview of the patients highlighted clinical symptoms suggesting NMS, allowing the pharmacists to alert the medical team.

WHAT IS NEW AND CONCLUSION

Adverse drug events may be severe and clinical pharmacists in emergency departments can help to detect them.