Overdosed paracetamol (acetaminophen) prescriptions and subsequent pharmacist interventions in French hospitals

Implementation of a pharmacist toxicology service on treatment of paracetamol (acetaminophen) overdose

INTRODUCTION

Paracetamol is a leading cause of fatality following a toxic ingestion. Individualized treatment is imperative in improving outcomes. Acetylcysteine is the standard of care for paracetamol overdose. Laboratory values and other clinical criteria can be used to guide treatment duration. Our hospital's protocol allows paracetamol overdose to be managed by the emergency department pharmacists. The purpose of this study was to evaluate the effect of a pharmacist toxicology service on the management of paracetamol overdose.

METHODS

This was a single center, retrospective, cohort evaluation. All patients receiving acetylcysteine were divided into pre- and post-implementation groups with data obtained from August 1, 2013 to January 14, 2018 and January 15, 2018 to September 30, 2021, respectively. The primary outcome was the frequency of individualized acetylcysteine therapy.

RESULTS

A total of 238 patients were screened for inclusion in the study with 120 patients included in the final analysis. There were 60 patients included in each cohort. The frequency of individualized acetylcysteine therapy was significantly higher in the post-implementation group versus the pre-implementation group (85% vs. 60% [95% CI 9.1-39.4; P = 0.002]).

CONCLUSIONS

The implementation of a pharmacist toxicology service correlated with increased poison center consultation as well as increased frequency of individualized acetylcysteine therapy and decreased number of missed acetylcysteine doses.

[The role of the community and hospital pharmacist in public health prevention in France]

INTRODUCTION

As the healthcare system changes, the pharmacist's place does. In this context the health institutions are looking for improving prevention and so realize how well-placed pharmacists were. For their competences as well as the trust patients are giving, they are serious actors in the implementation of prevention.

METHODS

We sought to understand which place pharmacists take in prevention policies. Thus, we have proceeded with an analysis of bibliography of the past ten years about articles registered in Medline talking about pharmacist's places in French prevention.

RESULTS

We have selected 47 articles classified according to San Marco's 3 levels of prevention: universal, oriented or targeted prevention. The pharmacist is involved in universal prevention, cancer screening or the proper use of antibiotics. In targeted prevention, they are specifically interested in the proper use of medicines and their correct prescription to patients. Finally, for targeted prevention, they offer patients therapeutic education adapted to their needs.

CONCLUSIONS

We can highlight that pharmacists improve consequently the patient's quality of life. They also enhance connections between health care professionals. Thanks to pharmacists, patients can find easy access and reliable health advice and government, trustworthy support for prevention.

CuS nanoparticles-enhanced luminol-O2 chemiluminescence reaction used for determination of paracetamol and vancomycin

A new chemiluminescence (CL) method was proposed to measure two widely used drugs, including paracetamol (PCM) and vancomycin (VAN). The CL reaction used was the CuS nanoparticles (CuS NPs)-luminol-O₂ system. In this system, CuS NPs played the role of catalyst and increased the CL intensity. CuS NPs were easily synthesized by quick-precipitation. CuS NPs were characterized by spectroscopic techniques, and the mean size of NPs was estimated to be about 9 nm. In the developed CL methods, PCM and VAN decreased the CL intensity. In the proposed method, the linear concentration ranges were 4.0 × 10^-5-4.0 × 10^-4 mol L^-1 of PCM and 2.0 × 10^-5-6.0 × 10^-4 mol L^-1 of VAN. The limit of detections were 2.9 × 10^-5 mol L^-1 and 8.9 × 10^-6 mol L^-1 for PCM and VAN, respectively. The relative standard deviations (RSD) of the CL method were 2.99 and 4.31 (n = 6) for the determination of 3.0 × 10^-4 mol L^-1 PCM and VAN, respectively. It was also shown that the CL methods can measure PCM and VAN concentrations in various real samples.

Promoting oral potassium administration in a tertiary care hospital: An eleven-year study

INTRODUCTION

Potassium is used to treat or prevent hypokalemia and exhibits all the characteristics of an intravenous to oral therapy conversion program. Despite this, the intravenous route for potassium replacement seems frequently unjustified.

OBJECTIVES

To determine the impact of a conversion program on the use of intravenous and oral galenic forms in a university tertiary care hospital.

METHODS

Two promotion campaigns were conducted in 2006 and 2009. The following years this was completed by pharmacist interventions during prescription analysis and face-to-face discussions with physicians during ward rounds. The consumption of products containing potassium was obtained by analyzing the hospital's financial database.

RESULTS

The proportion of the oral route increased from 18% in 2006 to 22% in 2011, and from 25% in 2012 to 44% in 2016; the increase was significantly greater in the second period (P<0.0001). In 2016, in emergency, pulmonology, infectious diseases, and cardiology departments, the proportion of oral use ranged from 57% and 82%. The greatest progression from 2006 to 2016 was found for intensive care (4% vs. 12%) and visceral surgery departments (9% vs. 34%) that increased approximately four-fold, followed by the emergency department (28% vs. 57%) that increased approximately two-fold.

CONCLUSION

Promoting the oral route for potassium replacement modifies prescriber habits and is followed by a notable increase in the proportion of potassium administered orally irrespective of department type.

[Prescription of acetaminophen in five French hospitals: What are the practices?]

AIM

Acetaminophen is widely used in hospital settings and often considered as nontoxic. We conducted a multicentric study in order to evaluate its proper use.

METHOD

Prescriptions from five general hospitals were analyzed, according to dose adjustments required in renal or liver failure, weight or chronic alcoholism, determined using a literature review. Other criteria have been assessed: indication for parenteral access, accuracy of administration time and pain assessment.

RESULTS

Among the 1256 analyzed prescriptions, 21% are non-compliants. The main causes of non-compliance (NC) are adjustments to weight and renal failure. Higher NC rates concern chronic alcoholism and liver failure.

CONCLUSION

Misuse of acetaminophen seems related to a lack of official recommendations concerning dose adjustments. Hospital pharmacists have an important role to play in the promotion of proper use of acetaminophen. Therefore we established a prescribing aid.

NCPDP recommendations for dose accumulation monitoring in the inpatient setting: Acetaminophen case model, version 1.0

PURPOSE

Best practices and guidance are provided for improved electronic detection and alerting of inadvertent supratherapeutic cumulative doses of acetaminophen and other medications with narrow therapeutic ranges in inpatient settings.

SUMMARY

Despite the use of medication safety technologies, overdosage and associated sentinel events continue to be serious problems in many inpatient settings. The tools needed to monitor and employ dose alerts, accumulators, and warning systems are available to reduce inadvertent overdose. Required are staff training and the implementation of processes that provide guidance and documentation of the drug reconciliation process from admittance to discharge for safe patient passage through the various transitions of care. Recommendations to achieve optimal patient safety outcomes include the adoption and integration of available technologies with full functionality configured to meet the institution's policies and processes, initial training and retraining of all staff who use these systems, continuing education of the patient care staff on the dosing safety requirements, and assigning a prominent role to the clinical pharmacist in the entire drug-use and reconciliation process.

CONCLUSION

The key factors contributing to inadvertent overdosage in inpatient settings include a lack of recognition of recommended maximum daily dosages; failure to optimally communicate medication information at transitions of care; failure to optimally implement medication safety technologies, particularly dose accumulator calculation features and associated alerts; and alert fatigue and override.

Nationwide evaluation of day-to-day clinical pharmacists' interventions in German hospitals

STUDY OBJECTIVE

To describe and evaluate the extent and diversity of nationwide data from clinical pharmacists' interventions (PIs) in German hospitals.

DESIGN

Retrospective analysis.

DATA SOURCE

The ADKA-DokuPIK German database, a national anonymous self-reported Internet-based documentation system for routine PIs as well as for medication errors reported by German hospital pharmacists.

MEASUREMENTS AND MAIN RESULTS

Data sets from ADKA-DokuPIK entered between January 2009 and December 2012 were analyzed descriptively. A total of 27,610 PIs were entered, mainly by ward-based clinical pharmacists (82.5%). Most of the PIs were performed on surgical wards (37.8%), followed by anesthesiology/intensive care unit/intermediate care unit and internal medicine. The most prevalent therapeutic subgroup that was the trigger for the PIs was antibacterials for systemic use (13.9%), followed by antithrombotic agents, analgesics, drugs for acid-related disorders, and agents acting on the renin-angiotensin system. About a quarter of interventions (23.4%) were performed due to inappropriate use of drugs, followed by use of a wrong dose or administration interval (22.1%), resulting in the most frequently taken actions of change of dose, change of drug, and drug stopped/paused (withheld). Altogether, the implementation rate of the PIs was 85.5%. Underlying medication errors were predominantly classified as "error, no harm" according to the National Coordinating Council for Medication Error Reporting and Prevention.

CONCLUSION

For the first time in a European country, our findings show the scope of clinical pharmacist involvement in patient care in daily clinical practice and demonstrate the usefulness and importance of their proactive interventions in the prevention of hazards and risks for hospital inpatients.