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Spaggiari S, Gehri M, Di Benedetto L, Hafen GM, Pauchard JY, Gervaix A, Pannatier A, Sadeghipour F, Di Paolo ER. Inhalation technique practical skills and knowledge among physicians and nurses in two pediatric emergency settings. J Asthma 2019; 58:190-196. [PMID: 31566459 DOI: 10.1080/02770903.2019.1674329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Correct technique with a pressurized metered-dose inhaler (pMDI) equipped with a valved holding chamber (VHC) or spacer provides an important advantage for adequate control of asthma and virus-induced wheezing in young children. The aim of this study was to assess the ability and knowledge of physicians and nurses to use a pMDI with a masked VHC in two pediatric emergency units.Methods: Study design: Two-center observational study. Inhaler use technique was assessed in 50 physicians and 50 nurses using a child mannequin and a validated videotaped nine-step scoring method. The participants' knowledge was evaluated by a questionnaire.Results: The inhalation technique was perfectly mastered by 49% of the study participants and almost perfectly mastered by another 34% (mean score 8.3 ± 0.7; range 5-9). Nurses were more likely than doctors to demonstrate the technique perfectly (66% vs. 32%, p < 0.05). The two most common errors were forgetting to shake the pMDI between two consecutive puffs (38% of the participants) and putting the patient in an incorrect position (11%). About half of the participants reported that they checked each patient's inhalation technique at every opportunity and knew how to clean the VHC. A large majority did not employ a reliable method to determine the amount of medication remaining in pMDIs without a counter.Conclusion: Healthcare professionals' practical skills and knowledge on inhalation therapy were not completely mastered and could be improved with a mandatory training program.
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Affiliation(s)
- Stéphanie Spaggiari
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Mario Gehri
- Children's Hospital, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurence Di Benedetto
- Children's Hospital, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gaudenz M Hafen
- Children's Hospital, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Respiratory Unit, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Yves Pauchard
- Children's Hospital, Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alain Gervaix
- Division of Pediatric Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - André Pannatier
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Farshid Sadeghipour
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Ermindo R Di Paolo
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Palmero D, Chavan E, Berger-Gryllaki M, Tolsa JF, Di Paolo ER, Pannatier A, Henry H, Sadeghipour F. Stability of prostaglandin E 1 solutions stored in polypropylene syringes for continuous intravenous administration to newborns. Eur J Hosp Pharm 2019; 25:e109-e114. [PMID: 31157079 DOI: 10.1136/ejhpharm-2017-001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/17/2017] [Accepted: 06/12/2017] [Indexed: 11/04/2022] Open
Abstract
Objective We aimed to monitor the physicochemical stability of prostaglandin E1 (PGE1) 1.5 and 15 µg/mL in 10% dextrose stored in polypropylene syringes. Methods We developed a liquid chromatography-high resolution mass spectrometry (LC-HRMS) method to detect and quantify levels of PGE1. Method selectivity was performed with a mixture of PGE1 and its degradation products. Forced degradation tests were performed to determine which degradation products were most likely to form. PGE1 injection solutions in 10% dextrose were stored in unprotected and shielded-from-light polypropylene syringes in a climatic chamber. Samples were taken immediately after preparation (T0) and after 24, 48, 72 and 168 hours for analysis. PGE1 solutions were considered stable if ≥90.0% of the initial concentration was retained. Results The LC-HRMS method was validated in the range of 0.086-0.200µg/mL PGE1 with trueness values between 98.2% and 100.3%, and repeatability and intermediate precision values of <2.2%and <4.7%, respectively. The quantification and detection limits of the method were 0.086 and 0.026µg/mL, respectively. PGE1 and its degradation products were resolved chromatographically. PGE1 injection solutions were≥90.0%stable after 48hours in unprotected from light (UPL) syringes. The solutions remained clear without precipitation, colour or pH modification and subvisible particles within the permitted levels. Prostaglandin A1 was the sole degradation product observed. Conclusions A LC-HRMS method to evaluate PGE1 stability in a 10% dextrose was developed and validated. PGE1 1.5 and 15µg/mL in 10% dextrose solution are stable for 48hours when stored at 30ºC in UPL polypropylene syringes.
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Affiliation(s)
- David Palmero
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
| | - Emilienne Chavan
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
| | | | | | - Ermindo R Di Paolo
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
| | - André Pannatier
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
| | - Hugues Henry
- Department of Biomedicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Farshid Sadeghipour
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
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3
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Palmero D, Di Paolo ER, Stadelmann C, Pannatier A, Sadeghipour F, Tolsa JF. Incident reports versus direct observation to identify medication errors and risk factors in hospitalised newborns. Eur J Pediatr 2019; 178:259-266. [PMID: 30460407 DOI: 10.1007/s00431-018-3294-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 11/26/2022]
Abstract
Newborns are often exposed to medication errors in hospitals. Identification and understanding the causes and risk factors associated with medication errors will help to improve the effectiveness of medication. We sought to compare voluntary incident reports and direct observation in the identification of medication errors. We also identified corresponding risk factors in order to establish measures to prevent medication errors. Medication errors identified by a clinical pharmacist and those recorded in our incident reporting system by caregivers were analysed. Main outcomes were rates, type and severity of medication error, and other variables related to medication errors. Ultimately, 383 medication errors were identified by the clinical pharmacist, and two medication errors were declared by caregivers. Prescription errors accounted for 38.4%, preparation errors for 16.2%, and administration errors for 45.4%. The two variables significantly related to the occurrence of medication errors were gestational age < 32.0 weeks (p = 0.04) and the number of drugs prescribed (p < 0.01).Conclusion: Caregivers underreported the true rate of medication errors. Most medication errors were caused by inattention and could have been limited by simplifying the medication process. Risk of medication errors is increased in newborns < 32.0 weeks and increases with the number of drugs prescribed to each patient. What is Known: • Newborns in hospitals are particularly susceptible to medication errors. • Identification and understanding the reasons for medication errors should help us to establish preventive measures to reduce the occurrence of such errors. What is New: • Direct observation of the medication process, though time consuming, is essential to accurately assess the frequency of medication errors, which are underreported by caregivers. Most medication errors are caused by inattention and could be limited by simplifying the medication process. • The risk of medication errors was significantly increased in very preterm newborns (< 32 weeks) and when the number of prescription per patient increased.
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Affiliation(s)
- David Palmero
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland.
| | - Ermindo R Di Paolo
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
| | - Corinne Stadelmann
- Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | - André Pannatier
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
- School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
| | - Farshid Sadeghipour
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
- School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
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4
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Ratsimbazafimahefa HR, Sadeghipour F, Trouiller P, Pannatier A, Allenet B. Description and analysis of hospital pharmacies in Madagascar. Ann Pharm Fr 2018; 76:218-227. [PMID: 29352583 DOI: 10.1016/j.pharma.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Madagascar's health care system has operated without formal hospital pharmacies for more than two decades. The gradual integration of pharmacists in public hospitals since 2012 will allow the structuring of this field. This study was conducted to characterize the current situation regarding all aspects relating to the general functioning of hospital pharmacies and the services provided. METHODS This qualitative research used semi-structured interviews. Interviewees' perceptions about the general organization and functioning of hospital pharmacies and details on services provided were collected. The 16 interviewees were Ministry of Health staff members involved in hospital pharmacy, hospital directors, medical staff members and hospital pharmacy managers. Interviews were recorded, translated into French if conducted in Malagasy, and fully transcribed. Verbatim transcripts were coded according to the themes of hospital pharmacy and topical content analysis was performed. RESULTS The principal issue perceived by interviewees was the heterogeneity of the system in terms of technical and financing management, with a main impact on the restocking of pharmaceutical products. The drug supply chain is not under control: no internal procedure has been established for the selection of pharmaceutical products, the quantification of needs is complex, stock management is difficult to supervise, a standard prescription protocol is lacking, dispensing is performed by unqualified staff, no pharmaceutical preparation is manufactured in the hospitals and administration occurs without pharmaceutical support. CONCLUSIONS Progressive structuring of efficient hospital pharmacy services using the Basel statements for the future of hospital pharmacy is urgently needed to improve health care in Madagascar.
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Affiliation(s)
- H R Ratsimbazafimahefa
- School of Pharmacy, University of Antananarivo, Antananarivo Madagascar; Campus Ambohitsaina, BP 375, Antananarivo 101, Madagascar.
| | - F Sadeghipour
- Pharmacy Department of University Hospitals of Lausanne, 1211 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, 1211 Geneva, Switzerland.
| | - P Trouiller
- Grenoble Alpes University Hospital, 38043 Grenoble, France; School of Pharmacy of Grenoble, 38043 Grenoble, France.
| | - A Pannatier
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, 1211 Geneva, Switzerland.
| | - B Allenet
- Grenoble Alpes University Hospital, 38043 Grenoble, France; School of Pharmacy of Grenoble Alpes, 38043 Grenoble, France; Techniques for Evaluation and Modeling of Health Actions (ThEMAS), Techniques for biomedical engineering and complexity management-informatics, mathematics and applications (TIMC-IMAG), National Institute of Sciences of the Universe-Research Unit 5525 (UMR CNRS), Grenoble Alpes University, 38043 Grenoble, France.
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5
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Hannou S, Voirol P, Pannatier A, Weibel ML, Sadeghipour F, von Gunten A, Mall JF, De Giorgi Salamun I. Pharmacist intervention acceptance for the reduction of potentially inappropriate drug prescribing in acute psychiatry. Int J Clin Pharm 2017; 39:1228-1236. [PMID: 28905171 DOI: 10.1007/s11096-017-0513-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 07/19/2017] [Indexed: 12/28/2022]
Abstract
Background Prescribing for the elderly is challenging. A previous observational study conducted in our geriatric psychiatry admission unit (GPAU) using STOPP/START criteria showed a high number of potentially inappropriate drug prescriptions (PIDPs). A clinical pharmacist was added to our GPAU as a strategy to reduce PIDPs. Objective The objective of the present study was to assess the impact of a clinical pharmacist on PIDPs by measuring acceptance rates of pharmacist interventions (PhIs). Setting This study was conducted at the GPAU of Lausanne University Hospital. Method The clinical pharmacist attended four GPAU meetings weekly. Complete medication reviews were performed daily. The clinical pharmacist conducted standard analyses based on clinical judgment and STOPP/START criteria assessment. A PhI was generated when a PIDP was detected. When a PhI was accepted, the PIDP was considered as eliminated. Acceptance rate of PhI was calculated (number of PhI accepted/total number of PhI). Main outcome measure PhIs acceptance rates. Results In a cohort of 102 patients seen between July 2013 and February 2014, a total of 697 PhIs (average 6.8/patient) were made based on standard evaluation (n = 479) and STOPP/START criteria (n = 243). The global acceptance rate was 68% (standard, 78%; STOPP/START, 47%). Conclusion Good PhIs acceptance rates demonstrated that a clinical pharmacist can reduce PIDPs in a GPAU. PhIs based on standard evaluation had a higher acceptance than those based on STOPP/START criteria, probably because they are better adapted to individual patients. However, these two evaluation approaches can be used in a complementary manner.
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Affiliation(s)
- Sophia Hannou
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Voirol
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne University, Lausanne, Switzerland
| | - André Pannatier
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne University, Lausanne, Switzerland
| | | | - Farshid Sadeghipour
- Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne University, Lausanne, Switzerland
| | - Armin von Gunten
- Geriatric Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Frédéric Mall
- Geriatric Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
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6
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Fournier A, Voirol P, Krähenbühl M, Bonnemain CL, Fournier C, Pantet O, Pagani JL, Revelly JP, Dupuis-Lozeron E, Sadeghipour F, Pannatier A, Eggimann P, Que YA. Antibiotic consumption to detect epidemics of Pseudomonas aeruginosa in a burn centre: A paradigm shift in the epidemiological surveillance of Pseudomonas aeruginosa nosocomial infections. Burns 2016; 42:564-70. [DOI: 10.1016/j.burns.2015.10.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/30/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022]
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Devaud JC, Berger MM, Pannatier A, Sadeghipour F, Voirol P. Does the type of parenteral lipids matter? A clinical hint in critical illness. Clin Nutr 2016; 36:491-496. [PMID: 26829880 DOI: 10.1016/j.clnu.2016.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/10/2016] [Accepted: 01/12/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS An altered lipid profile is common among intensive care unit (ICU) patients, but evidence regarding the impact of different fatty acid (FA) emulsions administered to patients requiring parenteral nutrition (PN) is scarce. This study aimed to compare the plasma triglycerides (TG) response to two types of commercial lipid emulsions: a structured mixture of long- and medium-chain triglycerides (LCT/MCT) or LCTs with n-9 FA (LCT+) in ICU patients. METHODS In this retrospective observational study conducted in a multidisciplinary ICU: two groups were defined by the type of emulsion used. Inclusion criteria were: consecutive patients on PN staying ≥4 days with one TG determination before commencing PN and at least one during PN. Recorded variables included energy intake, amount and type of nutritional lipids, propofol dose, glucose and protein intake, laboratory parameters, and all drugs received. Hypertriglyceridemia (hyperTG) was defined as TG >2 mmol/L. RESULTS The dynamic impact of the emulsion was analyzed in 187/757 patients completing the inclusion criteria (112 LCT/MCT and 75 LCT+). The demographic variables, severity indices, diagnostic categories, and outcomes did not differ between the two groups. Seventy-seven patients (41%) presented hyperTG. Both groups received similar daily energy (1604 versus 1511 kcal/day), lipids (60 versus 61 g/day), and glucose intake (233 versus 197 g/day). There was no increase of TG concentration in those receiving the LCT/MCT emulsion compared to those receiving the LCT+ emulsion (0 and 0.2 mmol/L, respectively, p < 0.05). CONCLUSION LCT/MCT emulsions are associated with a less pronounced increase of plasma TG levels than LCT+ emulsions.
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Affiliation(s)
- J-C Devaud
- Service of Pharmacy, Lausanne University Hospital, Switzerland; School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland.
| | - M M Berger
- Service of Adult Intensive Care Medicine & Burns, Lausanne University Hospital, Switzerland
| | - A Pannatier
- Service of Pharmacy, Lausanne University Hospital, Switzerland; School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland
| | - F Sadeghipour
- Service of Pharmacy, Lausanne University Hospital, Switzerland; School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland
| | - P Voirol
- Service of Pharmacy, Lausanne University Hospital, Switzerland; School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland
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Palmero D, Di Paolo ER, Beauport L, Pannatier A, Tolsa JF. A bundle with a preformatted medical order sheet and an introductory course to reduce prescription errors in neonates. Eur J Pediatr 2016; 175:113-9. [PMID: 26272253 DOI: 10.1007/s00431-015-2607-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/23/2015] [Accepted: 07/27/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED The objective of this study was to assess whether the introduction of a new preformatted medical order sheet coupled with an introductory course affected prescription quality and the frequency of errors during the prescription stage in a neonatal intensive care unit (NICU). Two-phase observational study consisting of two consecutive 4-month phases: pre-intervention (phase 0) and post-intervention (phase I) conducted in an 11-bed NICU in a Swiss university hospital. Interventions consisted of the introduction of a new preformatted medical order sheet with explicit information supplied, coupled with a staff introductory course on appropriate prescription and medication errors. The main outcomes measured were formal aspects of prescription and frequency and nature of prescription errors. Eighty-three and 81 patients were included in phase 0 and phase I, respectively. A total of 505 handwritten prescriptions in phase 0 and 525 in phase I were analysed. The rate of prescription errors decreased significantly from 28.9% in phase 0 to 13.5% in phase I (p < 0.05). Compared with phase 0, dose errors, name confusion and errors in frequency and rate of drug administration decreased in phase I, from 5.4 to 2.7% (p < 0.05), 5.9 to 0.2% (p < 0.05), 3.6 to 0.2% (p < 0.05), and 4.7 to 2.1% (p < 0.05), respectively. The rate of incomplete and ambiguous prescriptions decreased from 44.2 to 25.7 and 8.5 to 3.2% (p < 0.05), respectively. CONCLUSION Inexpensive and simple interventions can improve the intelligibility of prescriptions and reduce medication errors. WHAT IS KNOWN Medication errors are frequent in NICUs and prescription is one of the most critical steps. CPOE reduce prescription errors, but their implementation is not available everywhere. WHAT IS NEW Preformatted medical order sheet coupled with an introductory course decrease medication errors in a NICU. Preformatted medical order sheet is an inexpensive and readily implemented alternative to CPOE.
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Affiliation(s)
- David Palmero
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland. .,Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland. .,School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland.
| | - Ermindo R Di Paolo
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.
| | - Lydie Beauport
- Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland.
| | - André Pannatier
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.
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9
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Fournier A, Eggimann P, Pantet O, Krähenbühl M, Bonnemain CL, Fournier C, Pagani JL, Revelly JP, Dupuis-Lozeron E, Sadeghipour F, Pannatier A, Voirol P, Que YA. Antibiotics’ consumption to early detect epidemics of P. aeruginosa in a burn center: a paradigm shift in the epidemiological surveillance of nosocomial infections. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475037 DOI: 10.1186/2047-2994-4-s1-p232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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Di Paolo ER, Spaggiari S, Pannatier A, Sadeghipour F, Rochat I, Hafen GM. Stop using the flotation technique and start weighing salbutamol pressurised metered-dose inhalers without dose counters. Swiss Med Wkly 2015; 145:w14162. [PMID: 26230136 DOI: 10.4414/smw.2015.14162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Salbutamol pressurised metered-dose inhalers (pMDIs) are not equipped with dose counters outside the USA. The aim of this study was to describe a simple reproducible method for determining the number of doses remaining in a pMDI based on scale weight. With a laboratory scale, the mean weight of the canisters was 28.61 ± 0.10 g after priming and 14.84 ± 0.23 g after 200 puffs. Similar results were obtained with two common digital scales. We recommend weighing salbutamol canisters on a common digital scale, and replacing an old pMDI with a new one when the weight falls to ≤15 g.
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Affiliation(s)
| | | | - André Pannatier
- Department of Pharmacy, Lausanne University Hospital, Switzerland
| | | | - Isabelle Rochat
- Respiratory Unit, Department of Paediatrics, Lausanne University Hospital, Switzerland
| | - Gaudenz M Hafen
- Respiratory Unit, Department of Paediatrics, Lausanne University Hospital, Switzerland
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11
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Voirol P, Berger-Gryllaki M, Pannatier A, Eggimann P, Sadeghipour F. Visual compatibility of insulin aspart with intravenous drugs frequently used in ICU:. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2014-000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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12
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Spaggiari S, Hafen G, De Goumoens L, Gehri M, Di Paolo E, Pannatier A. CP-126 Validation of inhalation technique videotaped in asthmatic children under 5 years. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Fournier A, Eggimann P, Pagani JL, Revelly JP, Decosterd LA, Marchetti O, Pannatier A, Voirol P, Que YA. Impact of the introduction of real-time therapeutic drug monitoring on empirical doses of carbapenems in critically ill burn patients. Burns 2015; 41:956-68. [PMID: 25678084 DOI: 10.1016/j.burns.2015.01.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/15/2014] [Accepted: 01/05/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE Adequate empirical antibiotic dose selection for critically ill burn patients is difficult due to extreme variability in drug pharmacokinetics. Therapeutic drug monitoring (TDM) may aid antibiotic prescription and implementation of initial empirical antimicrobial dosage recommendations. This study evaluated how gradual TDM introduction altered empirical dosages of meropenem and imipenem/cilastatin in our burn ICU. METHODS Imipenem/cilastatin and meropenem use and daily empirical dosage at a five-bed burn ICU were analyzed retrospectively. Data for all burn admissions between 2001 and 2011 were extracted from the hospital's computerized information system. For each patient receiving a carbapenem, episodes of infection were reviewed and scored according to predefined criteria. Carbapenem trough serum levels were characterized. Prior to May 2007, TDM was available only by special request. Real-time carbapenem TDM was introduced in June 2007; it was initially available weekly and has been available 4 days a week since 2010. RESULTS Of 365 patients, 229 (63%) received antibiotics (109 received carbapenems). Of 23 TDM determinations for imipenem/cilastatin, none exceeded the predefined upper limit and 11 (47.8%) were insufficient; the number of TDM requests was correlated with daily dose (r=0.7). Similar numbers of inappropriate meropenem trough levels (30.4%) were below and above the upper limit. Real-time TDM introduction increased the empirical dose of imipenem/cilastatin, but not meropenem. CONCLUSIONS Real-time carbapenem TDM availability significantly altered the empirical daily dosage of imipenem/cilastatin at our burn ICU. Further studies are needed to evaluate the individual impact of TDM-based antibiotic adjustment on infection outcomes in these patients.
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Affiliation(s)
- Anne Fournier
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Philippe Eggimann
- Service of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean-Luc Pagani
- Service of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean-Pierre Revelly
- Service of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Laurent A Decosterd
- Service of Biomedicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Oscar Marchetti
- Service of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - André Pannatier
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre Voirol
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Yok-Ai Que
- Service of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Sidler-Moix AL, Di Paolo ER, Dolci U, Berger-Gryllaki M, Cotting J, Pannatier A. Physicochemical aspects and efficiency of albuterol nebulization: comparison of three aerosol types in an in vitro pediatric model. Respir Care 2014; 60:38-46. [PMID: 25516995 DOI: 10.4187/respcare.02490] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Advances in nebulizer design have produced both ultrasonic nebulizers and devices based on a vibrating mesh (vibrating mesh nebulizers), which are expected to enhance the efficiency of aerosol drug therapy. The aim of this study was to compare 4 different nebulizers, of 3 different types, in an in vitro model using albuterol delivery and physical characteristics as benchmarks. METHODS The following nebulizers were tested: Sidestream Disposable jet nebulizer, Multisonic Infra Control ultrasonic nebulizer, and the Aerogen Pro and Aerogen Solo vibrating mesh nebulizers. Aerosol duration, temperature, and drug solution osmolality were measured during nebulization. Albuterol delivery was measured by a high-performance liquid chromatography system with fluorometric detection. The droplet size distribution was analyzed with a laser granulometer. RESULTS The ultrasonic nebulizer was the fastest device based on the duration of nebulization; the jet nebulizer was the slowest. Solution temperature decreased during nebulization when the jet nebulizer and vibrating mesh nebulizers were used, but it increased with the ultrasonic nebulizer. Osmolality was stable during nebulization with the vibrating mesh nebulizers, but increased with the jet nebulizer and ultrasonic nebulizer, indicating solvent evaporation. Albuterol delivery was 1.6 and 2.3 times higher with the ultrasonic nebulizer and vibrating mesh nebulizers devices, respectively, than with the jet nebulizer. Particle size was significantly higher with the ultrasonic nebulizer. CONCLUSIONS The in vitro model was effective for comparing nebulizer types, demonstrating important differences between nebulizer types. The new devices, both the ultrasonic nebulizers and vibrating mesh nebulizers, delivered more aerosolized drug than traditional jet nebulizers.
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Affiliation(s)
- Anne-Laure Sidler-Moix
- Department of Pharmacy, University Hospital, Lausanne School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
| | | | - Ugo Dolci
- Department of Pharmacy, University Hospital, Lausanne
| | | | - Jacques Cotting
- Pediatric Intensive Care Unit, University Hospital, Lausanne
| | - André Pannatier
- Department of Pharmacy, University Hospital, Lausanne School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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15
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Humbert-Delaloye V, Berger-Gryllaki M, Voirol P, Testa B, Pannatier A. Screening for physicochemical incompatibilities of intravenous drugs in intensive care units: the case of monobasic potassium phosphate and furosemide. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Palmero D, Di Paolo ER, Tolsa JF, Pannatier A. PS-069 Introducing a preformatted medical order sheet and a taught course to decrease prescription errors in newborns. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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17
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Feka A, Fournier A, Perrottet N, Thein E, Demartines N, Pannatier A, Voirol P. CP-154 Metamizole and post operative analgesia: are the guidelines respected? Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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18
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Hannou S, Pannatier A, Von Gunten A, Voirol P, Mall JF, De Giorgi I, De Boer E. CP-076 Effects of pharmacist interventions on inappropriate prescribing in a geriatric psychiatry unit. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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19
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Bez C, Perrottet N, Zingg T, Leung Ki EL, Demartines N, Pannatier A. Stress ulcer prophylaxis in non-critically ill patients: a prospective evaluation of current practice in a general surgery department. J Eval Clin Pract 2013; 19:374-8. [PMID: 22420909 DOI: 10.1111/j.1365-2753.2012.01838.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES There is little evidence regarding the benefit of stress ulcer prophylaxis (SUP) outside a critical care setting. Overprescription of SUP is not devoid of risks. This prospective study aimed to evaluate the use of proton pump inhibitors (PPIs) for SUP in a general surgery department. METHOD Data collection was performed prospectively during an 8-week period on patients hospitalized in a general surgery department (58 beds) by pharmacists. Patients with a PPI prescription for the treatment of ulcers, gastro-oesophageal reflux disease, oesophagitis or epigastric pain were excluded. Patients admitted twice during the study period were not reincluded. The American Society of Health-System Pharmacists guidelines on SUP were used to assess the appropriateness of de novo PPI prescriptions. RESULTS Among 255 patients in the study, 138 (54%) received a prophylaxis with PPI, of which 86 (62%) were de novo PPI prescriptions. A total of 129 patients (94%) received esomeprazole (according to the hospital drug policy). The most frequent dosage was at 40 mg once daily. Use of PPI for SUP was evaluated in 67 patients. A total of 53 patients (79%) had no risk factors for SUP. Twelve and two patients had one or two risk factors, respectively. At discharge, PPI prophylaxis was continued in 33% of patients with a de novo PPI prescription. CONCLUSIONS This study highlights the overuse of PPIs in non-intensive care unit patients and the inappropriate continuation of PPI prescriptions at discharge. Treatment recommendations for SUP are needed to restrict PPI use for justified indications.
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Affiliation(s)
- Coraline Bez
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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20
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Humbert-Delaloye V, Berger-Gryllaki M, Voirol P, Gattlen L, Pannatier A. In vitro compatibility of various cardioactive drugs during simulated Y-site administration. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2012-000239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Berthouzoz S, Berger L, Bonnabry P, Pannatier A. The hospital pharmacist: an important contributor to improved patient safety in the hospital. Chimia (Aarau) 2012; 66:300-3. [PMID: 22867540 DOI: 10.2533/chimia.2012.300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Injectable drugs are high-risk products and their reconstitution in hospital wards is a potential source of errors. Thus, in order to secure the reconstitution process and thereby improve safety, the pharmacy department of Lausanne University Hospital is focusing on developing ready-to-use forms (CIVAS). These preparations are compounded in controlled clean rooms and are analyzed prior to release. In the intensive care unit, amiodarone 12.5 mg/mL in glucose 5% is one of the high-risk preparations, which has led the pharmacy to develop a ready-to-use solution. To this end, a one-year stability study was initiated, and the preliminary results (after six months) are illustrated here. A stability-indicating HPLC method was developed and validated for monitoring the concentration of amiodarone. Batches were stored at 5 °C and 30 °C, which were analyzed immediately after preparation, after one, two, four and six months of storage. The pH and osmolality values were monitored at the respective time intervals. It was observed that after six months, all the results were within specifications. However, the pH values started to decrease after two months when amiodarone was stored at 30 °C. After six months, a degradation peak appeared on the chromatogram of these solutions, which suggested that amiodarone is more stable at 5 °C. The preliminary results obtained in this study indicated that injectable amiodarone solutions are stable for six months under refrigerated storage conditions. The study is ongoing.
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Affiliation(s)
- Stéphanie Berthouzoz
- Department of Pharmacy, University Hospital Lausanne University Hospital Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
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22
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Carron C, Voirol P, Eggimann P, Pannatier A, Chioléro R, Wasserfallen JB. Five-year evolution of drug prescribing in a university adult intensive care unit. Appl Health Econ Health Policy 2012; 10:355-358. [PMID: 22809277 DOI: 10.1007/bf03261869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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23
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Grouzmann M, Lamon S, Podilsky G, Pannatier A. Batch or named-patient preparation: introduction of a decision algorithm. Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2012-000074.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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24
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Humbert-Delaloye V, Berger M, Voirol P, Pannatier A. In vitro compatibility of remifentanil hydrochloride and sufentanil citrate with selected drugs. Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2011-000039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Sidler-Moix AL, Mercier T, Decosterd LA, Di Paolo ER, Berger-Gryllaki M, Cotting J, Pannatier A. A highly sensitive LC-tandem MS assay for the measurement in plasma and in urine of salbutamol administered by nebulization during mechanical ventilation in healthy volunteers. Biomed Chromatogr 2011; 26:672-80. [DOI: 10.1002/bmc.1718] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 08/13/2011] [Indexed: 11/11/2022]
Affiliation(s)
| | - Thomas Mercier
- Division of Clinical Pharmacology and Toxicology; University Hospital; Lausanne; Switzerland
| | - Laurent A. Decosterd
- Division of Clinical Pharmacology and Toxicology; University Hospital; Lausanne; Switzerland
| | | | | | - Jacques Cotting
- Pediatric Intensive Care Unit; University Hospital; Lausanne; Switzerland
| | - André Pannatier
- Department of Pharmacy; University Hospital; Lausanne; Switzerland
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26
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Plüss-Suard C, Pannatier A, Kronenberg A, Mühlemann K, Zanetti G. Hospital antibiotic consumption in Switzerland: comparison of a multicultural country with Europe. J Hosp Infect 2011; 79:166-71. [DOI: 10.1016/j.jhin.2011.05.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 05/13/2011] [Indexed: 12/31/2022]
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27
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Devaud JC, Voirol P, Marques-Vidal P, Tappy L, Rodondi N, Chiolero R, Berger MM, Pannatier A. Risk factors for hypertriglyceridemia in the intensive care unit: an exploratory study. Crit Care 2010. [PMCID: PMC2934432 DOI: 10.1186/cc8818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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28
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Voirol P, Eggimann P, Carron C, Pannatier A, Chiolero R, Wasserfallen JB. Five-year evolution of drug prescribing in a university adult intensive care unit. Crit Care 2010. [PMCID: PMC2934347 DOI: 10.1186/cc8705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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29
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Mir C, Gadri A, Zelger GL, Pichon R, Pannatier A. Impact of a computerized physician order entry system on compliance with prescription accuracy requirements. ACTA ACUST UNITED AC 2009; 31:596-602. [PMID: 19554471 DOI: 10.1007/s11096-009-9306-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 05/19/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the change in non-compliant items in prescription orders following the implementation of a computerized physician order entry (CPOE) system named PreDiMed. SETTING The department of internal medicine (39 and 38 beds) in two regional hospitals in Canton Vaud, Switzerland. METHOD The prescription lines in 100 pre- and 100 post-implementation patients' files were classified according to three modes of administration (medicines for oral or other non-parenteral uses; medicines administered parenterally or via nasogastric tube; pro re nata (PRN), as needed) and analyzed for a number of relevant variables constitutive of medical prescriptions. MAIN OUTCOME MEASURE The monitored variables depended on the pharmaceutical category and included mainly name of medicine, pharmaceutical form, posology and route of administration, diluting solution, flow rate and identification of prescriber. RESULTS In 2,099 prescription lines, the total number of non-compliant items was 2,265 before CPOE implementation, or 1.079 non-compliant items per line. Two-thirds of these were due to missing information, and the remaining third to incomplete information. In 2,074 prescription lines post-CPOE implementation, the number of non-compliant items had decreased to 221, or 0.107 non-compliant item per line, a dramatic 10-fold decrease (chi(2) = 4615; P < 10(-6)). Limitations of the computerized system were the risk for erroneous items in some non-prefilled fields and ambiguity due to a field with doses shown on commercial products. CONCLUSION The deployment of PreDiMed in two departments of internal medicine has led to a major improvement in formal aspects of physicians' prescriptions. Some limitations of the first version of PreDiMed were unveiled and are being corrected.
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Affiliation(s)
- Caroline Mir
- Pharmacie des Hôpitaux du Nord Vaudois et de la Broye (PHNVB), Entremonts 11, 1400, Yverdon-les-Bains, Switzerland
| | - Amina Gadri
- Pharmacie des Hôpitaux du Nord Vaudois et de la Broye (PHNVB), Entremonts 11, 1400, Yverdon-les-Bains, Switzerland
| | - Georges L Zelger
- Pharmacie des Hôpitaux du Nord Vaudois et de la Broye (PHNVB), Entremonts 11, 1400, Yverdon-les-Bains, Switzerland.
| | - Renaud Pichon
- Pharmacie des Hôpitaux du Nord Vaudois et de la Broye (PHNVB), Entremonts 11, 1400, Yverdon-les-Bains, Switzerland
| | - André Pannatier
- Department of Pharmacy, University Hospital Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, EPGL, University of Geneva, Geneva, Switzerland
- University of Lausanne, Lausanne, Switzerland
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30
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Santschi V, Rodondi N, Bugnon O, Pannatier A, Burnier M. [Monitoring drug adherence for hypertensive and dyslipidemic patients in networks of community-based pharmacists and physicians]. Rev Med Suisse 2008; 4:1928, 1930-2, 1934 passim. [PMID: 18847122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Patient adherence is often poor for hypertension and dyslipidaemia. A monitoring of drug adherence might improve these risk factors control, but little is known in ambulatory care. We conducted a randomised controlled study in networks of community-based pharmacists and physicians in the canton of Fribourg to examine whether monitoring drug adherence with an electronic monitor (MEMS) would improve risk factor control among treated, but uncontrolled hypertensive and dyslipidemic patients. The results indicate that MEMS achieve a better blood pressure control and lipid profile, although its implementation requires considerable resources. The study also shows the value of collaboration between physicians and pharmacists in the field of patient adherence to improve ambulatory care of patients with cardiovascular risk factors.
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Affiliation(s)
- Valérie Santschi
- Division de néphrologie et Consultation d'hypertension, CHUV, Lausanne
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31
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Podilsky G, Berger‐Gryllaki M, Testa B, Pannatier A. Development and Validation of an HPLC Method for the Simultaneous Monitoring of Bromazepam and Omeprazole. J LIQ CHROMATOGR R T 2008. [DOI: 10.1080/10826070801893508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Gregory Podilsky
- a Department of Pharmacy , University Hospital Centre , Lausanne, Switzerland
| | | | - Bernard Testa
- a Department of Pharmacy , University Hospital Centre , Lausanne, Switzerland
| | - André Pannatier
- a Department of Pharmacy , University Hospital Centre , Lausanne, Switzerland
- b School of Pharmaceutical Sciences , EPGL, University of Geneva, University of Lausanne , Switzerland
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32
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Voeffray M, Pannatier A, Stupp R, Fucina N, Leyvraz S, Wasserfallen JB. Effect of computerisation on the quality and safety of chemotherapy prescription. Qual Saf Health Care 2007; 15:418-21. [PMID: 17142590 PMCID: PMC2464896 DOI: 10.1136/qshc.2005.016808] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chemotherapy is prescribed according to protocols of several cycles. These protocols include not only therapeutic agents but also adjuvant solvents and inherent supportive care measures. Multiple errors can occur during the prescription, the transmission of documents and the drug delivery processes, and lead to potentially serious consequences. OBJECTIVE To assess the effect of a computerised physician order entry (CPOE) system on the number of errors in prescription recorded by the centralised chemotherapy unit of a pharmacy service in a university hospital. PATIENTS AND METHODS Existing chemotherapy protocols were standardised by a multidisciplinary team (composed of a doctor, a pharmacist and a nurse) and a CPOE system was developed from a File Maker Pro database. Chemotherapy protocols were progressively introduced into the CPOE system. The effect of the system on prescribing errors was measured over 15 months before and 21 months after starting computerised protocol prescription. Errors were classified as major (dosage and drug name) and minor (volume or type of infusion solution). RESULTS Before computerisation, 141 errors were recorded for 940 prescribed chemotherapy regimens (15%). After introduction of the CPOE system, 75 errors were recorded for 1505 prescribed chemotherapy regimens (5%). Of these errors, 69 (92%) were recorded in prescriptions that did not use a computerised protocol. A dramatic decrease in the number of errors was noticeable when 50% of the chemotherapy protocols were prescribed through the CPOE system. CONCLUSION Errors in chemotherapy prescription nearly disappeared after implementation of CPOE. The safety of chemotherapy prescription was markedly improved.
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Affiliation(s)
- Marc Voeffray
- Pharmacy Service, University Hospital, Lausanne, Switzerland
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33
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Di Paolo ER, Stoetter H, Cotting J, Frey P, Gehri M, Beck-Popovic M, Tolsa JF, Fanconi S, Pannatier A. Unlicensed and off-label drug use in a Swiss paediatric university hospital. Swiss Med Wkly 2006; 136:218-22. [PMID: 16633971 DOI: 2006/13/smw-11275] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Many medicines used in newborns, infants, children and adolescents are not licensed ("unlicensed") or are prescribed outside the terms of the marketing authorization ("off-label"). Several studies have shown that this is a common practice in various healthcare settings in the USA, Europe and Australia, but data are scarce in Switzerland. OBJECTIVES The aim of our prospective study was to determine the proportion of unlicensed or off-label prescriptions in paediatric patients. METHODS This pilot study was conducted prospectively over a six month period in the department of paediatrics of a university hospital. RESULTS Sixty patients aged from three days to 14 years were included in the study. A total of 483 prescriptions were written for the patients. More than half of all prescriptions (247; 51%) followed the terms of the marketing authorization. 114 (24%) were unlicensed and 122 (25%) off-label. All patients received at least one unlicensed or offlabel medicine. CONCLUSION The use of unlicensed or off-label medicines to treat children was found to be common. Co-operation between the pharmaceutical industry, national regulatory authorities, clinical researchers, healthcare professionals and parents is required in order to ensure that children do not remain "therapeutic orphans".
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Affiliation(s)
- Ermindo R Di Paolo
- Department of Pharmacy, University Hospital, CHUV, Lausanne, Switzerland
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34
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Livio F, Buclin T, Pannatier A, Biollaz J. [Generic drugs and legal incentives: which impact?]. Rev Med Suisse 2006; 2:966-9. [PMID: 16686328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The dispositions that regulate generic substitution in Switzerland have been recently revised, and impose definite incentives on prescribers. The benefits and drawbacks associated with the prescription of generic drugs are reviewed, considering the viewpoints of patients, practitioners and third party payers. While the initial prescription of a generic drug raises no specific concerns, the generic switch during long-term treatment may require some caution. The advantages of using International Nonproprietary Names (INN) for drug prescription are discussed. A renewal of prescription habits would be welcomed however several practical issues would have to find rational solutions.
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Affiliation(s)
- F Livio
- Division de pharmacologie et toxicologie cliniques, Hôpital de Beaumont, CHUV, Lausanne.
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35
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Di Paolo ER, Stoetter H, Cotting J, Frey P, Gehri M, Beck-Popovic M, Tolsa JF, Fanconi S, Pannatier A. Unlicensed and off-label drug use in a Swiss paediatric university hospital. Swiss Med Wkly 2006; 136:218-22. [PMID: 16633971 DOI: 10.4414/smw.2006.11275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Many medicines used in newborns, infants, children and adolescents are not licensed ("unlicensed") or are prescribed outside the terms of the marketing authorization ("off-label"). Several studies have shown that this is a common practice in various healthcare settings in the USA, Europe and Australia, but data are scarce in Switzerland. OBJECTIVES The aim of our prospective study was to determine the proportion of unlicensed or off-label prescriptions in paediatric patients. METHODS This pilot study was conducted prospectively over a six month period in the department of paediatrics of a university hospital. RESULTS Sixty patients aged from three days to 14 years were included in the study. A total of 483 prescriptions were written for the patients. More than half of all prescriptions (247; 51%) followed the terms of the marketing authorization. 114 (24%) were unlicensed and 122 (25%) off-label. All patients received at least one unlicensed or offlabel medicine. CONCLUSION The use of unlicensed or off-label medicines to treat children was found to be common. Co-operation between the pharmaceutical industry, national regulatory authorities, clinical researchers, healthcare professionals and parents is required in order to ensure that children do not remain "therapeutic orphans".
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Affiliation(s)
- Ermindo R Di Paolo
- Department of Pharmacy, University Hospital, CHUV, Lausanne, Switzerland
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36
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Wasserfallen JB, Shimia S, Biollaz J, Pannatier A. [Generic drug prescribing: pilot study on the impact of the new drug pricing system on costs and potential savings]. Rev Med Suisse 2006; 2:865-6, 868-71. [PMID: 16646370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The impact of a systematic generic substitution and of the new drug pricing system (implemented in 2002 for cost saving reasons) on prescription cost was computed on the basis of prescriptions delivered in January 1999 for patients leaving our university hospital. A total of 3,099 prescriptions, representing 5,514 drugs, were delivered in one month, of which 335 (6%) were excluded (drug not available in 2002 or magistral preparations). Forced generic prescription would have saved 3,8% of global costs, while the new drug pricing system would have increased costs between 1,1% and 8,0%. In this specific setting, savings linked with forced generic drug prescription was weak (4 to 5%), and the expected savings of the new drug pricing system were not observed.
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Affiliation(s)
- J B Wasserfallen
- Unité d'évaluation technologique, Direction médicale, Service de pharmacie, CHUV, Lausanne.
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Abstract
OBJECTIVE To determine the influence of jet nebulizer brands and nebulization mode on albuterol delivery in a mechanically ventilated pediatric lung model. DESIGN In vitro, laboratory study. SETTING Research laboratory of a university hospital. INTERVENTIONS Using albuterol as a marker, six jet nebulizers (Microneb NA420, Sidestream, Acorn II, Cirrus, Upmist, Micro Mist) were tested in four nebulization modes in a bench model mimicking the ventilatory pattern of a 10-kg infant (Galileo ventilator, Hamilton Medical). The amounts of albuterol deposited on the inspiratory filters at the end of the endotracheal tube were determined, as well as the pressure, flow profiles, and particle size distribution of the jet nebulizers. MEASUREMENTS AND MAIN RESULTS Pooling the data of the six jet nebulizer brands (n = 30) indicated that intermittent nebulization during the expiratory phase was more efficient (6.5 +/- 2.5% of the initial dose, p < .001) than intermittent nebulization during the inspiratory phase (1.9 +/- 1.2%) and continuous nebulization with air from the ventilator (4.0 +/- 1.5%) or from an external source (4.2 +/- 1.4%). The particle size distribution at 6 L x min(-1) was between 2.81 and 3.30 microm. CONCLUSIONS In our in vitro pediatric lung model, the quantity of inhaled drug was low. Jet nebulizer brands and nebulization modes significantly affected drug delivery, and in vitro models designed for adults cannot be extrapolated to infants.
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Affiliation(s)
- Ermindo R Di Paolo
- Department of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Gehri M, Guignard E, Djahnine SR, Cotting JQ, Yersin C, Di Paolo ER, Krahenbuhl JD, Pannatier A. When Fever, Paracetamol? Theory and Practice in a Paediatric Outpatient Clinic. ACTA ACUST UNITED AC 2005; 27:254-7. [PMID: 16096897 DOI: 10.1007/s11096-004-4771-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine how medical and nursing staff treat feverish children and compare the findings with their theoretical knowledge, evaluating how they might contribute to fever phobia in parents. SETTING Paediatric Emergency Department. METHOD In the first step, we analysed prospectively the files of all children having consulted the Paediatric Emergency Department with a history of fever or of body temperature above 38 degrees C during a 2-week period. The second step consisted of evaluating knowledge and perception of fever of doctors and nurses using a questionnaire. MAIN OUTCOME MEASURES Prospective study: final diagnosis (viral, non- invasive bacterial disorders, invasive bacterial disorders), site of measurement and average temperature. Evaluation of theoretical knowledge: definition of fever, site of measurement, evaluation of the child's clinical state, antipyretic drug choice. RESULTS A total of 114 children under 5 years of age were enrolled and 24 caregivers (12 doctors, 12 nurses, 90 of the staff) responded to the questionnaire. The results showed good consistency in theoretical knowledge, but an excessive fear about cerebral damage was also shown by doctors. This belief likely contributes to the transmission of fever phobia to parents. In contrast, analysis of children management showed that fever was often under-treated, especially by nurses and even more so by parents. Paracetamol remained the first-line antipyretic drug yet was often administered in insufficient doses. Non-steroidal anti-inflammatory drugs were seldom used, except by parents (16 of all the children). Contrary to literature, the favourite route of administration was the rectal one. Physical methods like sponging were largely used by nurses, despite the uncertainties in their real effectiveness and their known side-effects. CONCLUSION Our study showed that the management of feverish children was globally correct in the Paediatric Emergency Department, but several improvement measures have been taken (e.g. tables of normal and abnormal ranges of temperature, recommended temperature measurement techniques, dosage regimen of antipyretic drugs, guidelines to parents), justifying the implementation of a pharmaceutical follow-up.
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Affiliation(s)
- Mario Gehri
- Hôpital de l'Enfance de Lausanne, ch. de Montétan 16, 1000, Lausanne 7, Switzerland.
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Berger-Gryllaki M, Podilsky G, Widmer N, Gloor S, Testa B, Pannatier A. Formulation Optimization in a University Hospital: The Example of Pediatric Solutions of the ACE Inhibitor Captopril. Chimia (Aarau) 2005. [DOI: 10.2533/000942905777676362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Many major drugs are not available in pediatric form. As a result, hospital pharmacists are often requested to provide the medical staff with liquid formulations for individualized dosage and easy administration to newborn and young patients. Such in-house formulations must of course
fulfil stringent criteria of purity and stability. This paper reports the development of a liquid solution of captopril for pediatric use. A specific HPLC-UV method was developed. A number of formulations described in the literature as affording one-month stability were examined and found
wanting. A simple solution of the drug (1 mg/ml) in purified water containing 0.1% EDTA-Na proved chemically and microbiologically stable at room temperature for two years.
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Wasserfallen JB, Bütschi AJ, Muff P, Biollaz J, Schaller MD, Pannatier A, Revelly JP, Chiolero R. Format of medical order sheet improves security of antibiotics prescription: The experience of an intensive care unit. Crit Care Med 2004; 32:655-9. [PMID: 15090943 DOI: 10.1097/01.ccm.0000114835.97789.ab] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether formatting the medical order sheet has an effect on the accuracy and security of antibiotics prescription. DESIGN Prospective assessment of antibiotics prescription over time, before and after the intervention, in comparison with a control ward. SETTING The medical and surgical intensive care unit (ICU) of a university hospital. PATIENTS All patients hospitalized in the medical or surgical ICU between February 1 and April 30, 1997, and July 1 and August 31, 2000, for whom antibiotics were prescribed. INTERVENTION Formatting of the medical order sheet in the surgical ICU in 1998. MEASUREMENTS AND MAIN RESULTS Compliance with the American Society of Hospital Pharmacists' criteria for prescription safety was measured. The proportion of safe orders increased in both units, but the increase was 4.6 times greater in the surgical ICU (66% vs. 74% in the medical ICU and 48% vs. 74% in the surgical ICU). For unsafe orders, the proportion of ambiguous orders decreased by half in the medical ICU (9% vs. 17%) and nearly disappeared in the surgical ICU (1% vs. 30%). The only missing criterion remaining in the surgical ICU was the drug dose unit, which could not be preformatted. The aim of antibiotics prescription (either prophylactic or therapeutic) was indicated only in 51% of the order sheets. CONCLUSIONS Formatting of the order sheet markedly increased security of antibiotics prescription. These findings must be confirmed in other settings and with different drug classes. Formatting the medical order sheet decreases the potential for prescribing errors before full computerized prescription is available.
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Abstract
To evaluate the adequacy of pharmacological thromboembolic prevention in the medical ward of a university hospital, we performed a retrospective study in 227 consecutive inpatients. The presence of risk factors, and type, length, and dose of pharmacological prevention were documented by chart review. Only 22% of the 153 risk patients received adequate prevention, whereas 38% of the patients at low risk were given pharmacological prophylaxis. The high prevalence of over- and undertreatment is an indicator of less than optimal care. Quality of care interventions, such as the development of local guidelines, might improve the appropriateness of pharmacological thromboembolic prophylaxis in medical inpatients.
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Affiliation(s)
- Drahomir Aujesky
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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42
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Doser N, Kübli S, Telenti A, Marzolini C, Chave JP, Feihl F, Buclin T, Pannatier A, Darioli R, Nicod P, Waeber B, Mooser V. Efficacy and safety of fluvastatin in hyperlipidemic protease inhibitor-treated HIV-infected patients. AIDS 2002; 16:1982-3. [PMID: 12351967 DOI: 10.1097/00002030-200209270-00024] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gikic M, Di Paolo ER, Pannatier A, Cotting J. Evaluation of physicochemical incompatibilities during parenteral drug administration in a paediatric intensive care unit. Pharm World Sci 2000; 22:88-91. [PMID: 11028261 DOI: 10.1023/a:1008780126781] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients in paediatric intensive care units (PICU) often receive numerous medications by the parenteral route. Frequently two or more drugs are delivered simultaneously through the same line and the risk of physicochemical incompatibilities is thus important. The objectives of this study were 1) to identify prospectively the combinations of injectable drugs administered in the PICU of our university hospital and 2) to analyze them according to information found in the literature. The data were collected by a pharmacist over a 30-day period and classified in three categories: compatible, incompatible and undocumented. Nineteen patients were included in the study with a median age of 3.2 years. The mean number (+/- SD) of injectable drugs per patient and per day was 6.5 (+/- 2.8), for a total of 26 drugs and 7 solutes. 64 combinations of drugs were observed with 2 (31.3%), 3 (45.3%), 4 (10.9%) or 5 (12.5%) drugs. 81 drug-drug and 94 drug-solute combinations were recorded. Among these, 151 (86.3%) were compatible, 6 (3.4%) incompatible and 18 (10.3%) undocumented. The incompatibilities included furosemide (Lasix), a drug in alkaline solution and Vamina-Glucose, a total parenteral nutrition solution. No clinical consequences resulting from drug incompatibilities were shown in this study. We suggest that in vitro compatibility tests on standard drug combinations, as well as a training program for nurses on drug incompatibility problems would sensitively increase the security of parenteral drug administration.
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Affiliation(s)
- M Gikic
- Department of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Eggimann P, Francioli P, Bille J, Schneider R, Wu MM, Chapuis G, Chiolero R, Pannatier A, Schilling J, Geroulanos S, Glauser MP, Calandra T. Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med 1999; 27:1066-72. [PMID: 10397206 DOI: 10.1097/00003246-199906000-00019] [Citation(s) in RCA: 340] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of intravenous fluconazole for the prevention of intra-abdominal Candida infections in high-risk surgical patients. DESIGN Randomized, prospective, double-blind, placebo-controlled study. SETTING Two university-affiliated hospitals in Switzerland. PATIENTS Forty-nine surgical patients with recurrent gastrointestinal perforations or anastomotic leakages. INTERVENTIONS Prophylaxis with intravenous fluconazole (400 mg per day) or placebo continued until resolution of the underlying surgical condition. MEASUREMENTS AND MAIN RESULTS Patients were evaluated daily, and specimens for culture were obtained three times per week during prophylaxis. The primary study end points were the frequency of and the time to intra-abdominal Candida infections. Secondary end points were the frequency of candidiasis (intra-abdominal and extra-abdominal) and the emergence or persistence of Candida colonization. Among patients who were not colonized at study entry, Candida was isolated from surveillance cultures during prophylaxis in 15% of the patients in the fluconazole group and in 62% of the patients in the placebo group (relative risk, 0.25; 95% confidence interval, 0.07 to 0.96; p = .04). Candida peritonitis occurred in one of 23 patients (4%) who received fluconazole and in seven of 20 patients (35%) who received placebo (relative risk, 0.12; 95% confidence interval, 0.02 to 0.93; p = .02). In addition, one catheter-related Candida albicans sepsis occurred in a fluconazole-treated patient. Thus, overall, candidiasis developed in two fluconazole patients and seven placebo patients (relative risk, 0.25; 95% confidence interval, 0.06 to 1.06; p = .06). C. albicans accounted for 87% of the Candida species isolated before or during prophylaxis, and all C. albicans strains were susceptible to fluconazole. Fluconazole was well tolerated, and adverse events occurred at similar frequencies in both treatment groups. CONCLUSIONS Fluconazole prophylaxis prevents colonization and invasive intra-abdominal Candida infections in high-risk surgical patients.
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Affiliation(s)
- P Eggimann
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Schneider MP, Cotting J, Pannatier A. Evaluation of nurses' errors associated in the preparation and administration of medication in a pediatric intensive care unit. Pharm World Sci 1998; 20:178-82. [PMID: 9762730 DOI: 10.1023/a:1012087727393] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The objectives of this study were to determine the frequency and the types of errors which occur regarding the preparation and the administration of medication and to identify the main causes of these errors in a pediatric intensive care unit (PICU) at the University Hospital in Lausanne (Switzerland). In this prospective study, based on the observation of nurses' activities, the data were collected over a period of 10 weeks. The error classification was based on the American Society of Hospital Pharmacy (ASHP) definitions. The frequency of errors was calculated as the sum of all noted errors divided by the total administered drugs, plus the sum of all omitted drugs, multiplied by 100. The sum of all given doses plus all omitted doses gives the 'total opportunity for errors'. This total was 275 and the total frequency of errors was 26.9%. The most frequent errors were wrong-time errors (32.4%), wrong-administration-technique errors (32.4%) and preparation errors (23.0%). In relation with other studies conducted under comparable conditions, a lesser number of omissions and wrong-time errors were observed. On the contrary, administration-technique and dose-preparation errors were more frequent at our hospital. A program of systematic assistance and survey by professional pharmacists could improve the quality of the preparation and administration of medication in the PICU.
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Affiliation(s)
- M P Schneider
- Pharmacy Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Abstract
Total parenteral nutrition (TPN) has long been considered the optimal nutrition technique in critically ill patients, but recently the use of enteral nutrition (EN) has increased. This study describes the evolution of the different nutritional support techniques in a surgical intensive care unit (ICU) in a university hospital, through (1) a global survey over 10 y assessing the evolution of the use of EN and TPN, and (2) a prospective study performed over 6 mo. Severity of illness and diagnostic categories were stable (n = 11,539 patients). From 1986 to 1990, the proportion of TPN administered increased from 10-25% of ICU days, decreasing to 10% thereafter. EN was used in about 5% of ICU days in 1986, and had increased to 30% of total ICU treatment days in 1995. The proportion of nutrients actually delivered to the patients was 75% with EN and 88% with TPN. Major changes in nutritional support have been observed since 1986. The frequency of nutritional support provided in general has increased to 40% of ICU treatment days. TPN has been largely overtaken by EN, with the risk of insufficient energy delivery, related to the difficulties of EN in the critically ill. These results reinforce the importance of continuous quality control by daily assessment of nutrient supply.
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Affiliation(s)
- M M Berger
- Anesthesiology & Surgical Intensive Care Unit, C.H.U.V., University of Lausanne, Switzerland
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47
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Parret T, Schneider R, Rime B, Saghafi L, Pannatier A, Francioli P. [Evaluation of antibiotic use: a prospective study in a university hospital center]. Schweiz Med Wochenschr 1993; 123:403-413. [PMID: 8456259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The inappropriate use of antibiotics has been documented by several studies. Most of these studies have been performed in the USA and there is very little data from Europe and Switzerland. A three-month prospective study was carried out at the University Medical Center of Lausanne in the departments of internal medicine, general surgery and traumatology. During this period, 2112 patients were hospitalized among whom 878 received one or more courses of antibiotic therapy: the treatment was given prophylactically in 35% of the cases and therapeutically in the other 65%. A total of 1165 antibiotic prescriptions were evaluated. The administration of the antibiotic was considered to be indicated in 96% of the cases. However, 24% of the prescriptions contained at least one error. 50% of the errors were observed in prophylactic treatments and most were related to the length of administration and the spectrum of the agents. The errors in therapeutic prescription were found mainly in indications for urinary and respiratory tract infections, and were related to the spectrum of the antibiotic and the length of treatment. It was calculated that the inappropriate use of antibiotics accounted for approximately 7% of the total costs of all antibiotics used. We estimated that half of this excess in costs could probably be saved by the introduction of simple corrective measures mainly directed at limiting the duration of administration.
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Affiliation(s)
- T Parret
- Division autonome de Médecine préventive hospitalière, CHUV, Lausanne
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Gryllaki-Berger M, Mugny C, Perrenoud D, Pannatier A, Frenk E. A comparative study of formaldehyde detection using chromotropic acid, acetylacetone and HPLC in cosmetics and household cleaning products. Contact Dermatitis 1992; 26:149-54. [PMID: 1505179 DOI: 10.1111/j.1600-0536.1992.tb00284.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chromotropic acid and acetylacetone methods for qualitative determination of formaldehyde were tested in parallel on 48 commercial samples, with high-performance liquid chromotography (HPLC) implemented for quantitative measure. In addition, interference with the detection of formaldehyde was investigated by analyzing 12 other aldehydes and ketones, 7 essential oils and 3 polysorbates. Throughout this comparative study, the disadvantages of the chromotropic acid method, of which 2 variants were used, were delineated and we found that the acetylacetone test proved to be a more efficient screening method for formaldehyde detection in a clinical laboratory.
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Affiliation(s)
- M Gryllaki-Berger
- Department of Dermatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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50
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Di Paolo ER, Hirschi B, Pannatier A. Quantitative determination of particulate contamination in intravenous administration sets. Pharm Weekbl Sci 1990; 12:190-5. [PMID: 2255588 DOI: 10.1007/bf01980045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Particle counts were performed on 1,000 intravenous administration sets from ten suppliers on the Swiss market using a HIAC/Royco electronic counter. The following main conclusions may be drawn from the results of this study: --the small particles were the most numerous, regardless of the type of set; --the differences in the counts obtained for the different suppliers' sets tended to level off for particles larger than 10 microns; --the drip chamber and latex connector may be two important sources of particles; --the particulate contamination from the sets is relatively low compared with the amount of particles contained in the parenteral solutions.
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Affiliation(s)
- E R Di Paolo
- Service of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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